Transitional Pain Service may help Prevent Persistent Postsurgical Pain among Cancer Patients , finds meta analysis

Recent paper presents a systematic review and meta-analysis that evaluated the feasibility of transitional pain service (TPS) in pain practice among postsurgical cancer patients and its potential to prevent persistent postsurgical pain (PPSP) and chronic pain catastrophising. The review aimed to bridge the pain and period gap experienced by postsurgical patients as they transition from hospital care to home care. The lack of a dedicated pain service for postsurgical patients has led to the resurgence of TPS as a means to provide comprehensive pain management during the postsurgical period. The review included articles involving adult cancer patients undergoing cancer-related surgery and experiencing pain, and it targeted multimodal integrative pain management. A total of 374 articles were evaluated, and 14 manuscripts were included in the meta-analysis due to the lack of randomized controlled trials evaluating the efficacy of TPS in preventing PPSP and pain catastrophising. The meta-analysis with meta-regression was conducted to analyze the feasibility of TPS and its relation to pain-related patient outcomes. The review concluded that TPS interventions carried out by multidisciplinary teams have resulted in successful implementation with improved pain-related patient outcomes, mitigating the occurrence of PPSP. The paper also discussed the systematic review process, the lack of randomized controlled trials, and the methods used for analysis, including meta-regression and subgroup analysis. It evaluated the influence of various factors such as sample size, diagnostic test utility, and study populations on the feasibility of TPS. The analysis revealed notable disparities in the feasibility rates of TPS pain-related interventions among patients, with studies falling below the median sample size reporting a higher feasibility percentage. The paper also highlighted the potential role of TPS in achieving opioid sparing, de-escalating opioid use, and improving pain-related patient outcomes. Overall, the paper presents a detailed and comprehensive analysis of the feasibility of TPS in pain practice among postsurgical cancer patients, demonstrating its potential to prevent PPSP and chronic pain catastrophising. It underscores the importance of TPS as a means to provide comprehensive and individualized pain management during the postsurgical period, thereby improving patient outcomes and mitigating the occurrence of persistent postsurgical pain.

Key Points

1. The systematic review and meta-analysis focused on evaluating the feasibility of transitional pain service (TPS) in pain practice among postsurgical cancer patients and its potential to prevent persistent postsurgical pain (PPSP) and chronic pain catastrophising during the transition from hospital care to home care.

2. The lack of dedicated pain service for postsurgical patients has led to the resurgence of TPS as a means to provide comprehensive pain management during the postsurgical period. The review included articles involving adult cancer patients undergoing cancer-related surgery and experiencing pain, targeting multimodal integrative pain management.

3. A total of 374 articles were evaluated, and 14 manuscripts were included in the meta-analysis due to the lack of randomized controlled trials evaluating the efficacy of TPS in preventing PPSP and pain catastrophising. The review concluded that TPS interventions carried out by multidisciplinary teams have resulted in successful implementation with improved pain-related patient outcomes, mitigating the occurrence of PPSP.

4. The paper discussed the systematic review process, the lack of randomized controlled trials, and the methods used for analysis, including meta-regression and subgroup analysis to evaluate the influence of various factors such as sample size, diagnostic test utility, and study populations on the feasibility of TPS. The analysis revealed notable disparities in the feasibility rates of TPS pain-related interventions among patients, with studies falling below the median sample size reporting a higher feasibility percentage.

5. The analysis also highlighted the potential role of TPS in achieving opioid sparing, de-escalating opioid use, and improving pain-related patient outcomes. It emphasizes the importance of TPS in providing comprehensive and individualized pain management during the postsurgical period, thereby improving patient outcomes and mitigating the occurrence of persistent postsurgical pain.

6. Overall, the paper provides a detailed and comprehensive analysis of the feasibility of TPS in pain practice among postsurgical cancer patients, demonstrating its potential to prevent PPSP and chronic pain catastrophising, and showcasing its role in improving patient outcomes during the postsurgical period.

Reference -

Thota RS, Ramkiran S, Jayant A, Kumar KS, Wajekar A, Iyer S, et al. Bridging the pain gap aftercancer surgery – Evaluating the feasibility of transitional pain service to prevent persistent postsurgical pain – A systematic review and meta‑analysis. Indian J Anaesth 2024;68:861‑74