A transitional pain management program is associated with reduced opioid dependence after major shoulder surgery

Area of Science:

• Orthopedic Surgery
• Pain Management
• Public Health

Background:

• Opioid overprescription in the U.S. leads to dependence, overdose, and death.
• Increased opioid use during orthopedic shoulder surgery is a risk factor for long-term opioid dependence.
• A multidisciplinary perioperative pain management program (Transitional Pain Service [TPS]) was hypothesized to reduce postoperative opioid requirements.

Purpose of the Study:

• To evaluate the effectiveness of a Transitional Pain Service (TPS) in reducing postoperative opioid consumption after major shoulder surgery.
• To compare opioid use in patients managed by TPS versus a historical cohort.
• To identify factors associated with persistent opioid use after shoulder surgery.

Main Methods:

• Implementation of a TPS focused on nonopioid pain management and cessation support at a Veterans Affairs Medical Center.
• Comparison of opioid consumption in patients undergoing total shoulder arthroplasty (TSA) or rotator cuff repair (RCR) with a historical cohort.
• Primary outcome: proportion of patients using opioids at 90 days postoperatively. Secondary outcomes: pain scores, time to cessation, and tablets consumed.

Main Results:

• The TPS group showed significantly decreased persistent opioid use at 90 days (12.6% vs. 28.6%, P = .018).
• Predictors of increased opioid use included longer length of stay, anxiety diagnosis, and rotator cuff repair (RCR) compared to total shoulder arthroplasty (TSA).
• Median time to opioid cessation was shorter for TSA (6 days) than RCR (8 days), with reduced pain scores observed post-discharge.

Conclusions:

• A TPS effectively reduces opioid use in patients undergoing shoulder surgery at 90 days postoperatively compared to historical controls.
• Fewer opioid tablets prescribed at discharge, managing anxiety, and optimizing length of stay are modifiable factors to reduce opioid consumption.
• Implementing multidisciplinary perioperative pain management programs like TPS can significantly mitigate opioid overprescribing nationally.