Transitional Pain Service may improve pain-related patient outcomes and achieve opioid sparing after cancer surgery finds study

Many cancer centers provide comprehensive acute and chronic pain services. However, the period following hospital discharge and returning to normal activities poses a vulnerable time for patients experiencing postsurgical pain. Interestingly, the transition from hospital to home and subsequent follow-up visits leads to a gap in pain management. This gap may stem from the absence of a specialized pain service, and the failure to address it has contributed to the development of persistent postsurgical pain (PPSP). Recent systematic review and meta-analysis evaluated the feasibility and effectiveness of transitional pain service (TPS) interventions in addressing persistent postsurgical pain (PPSP) and pain catastrophizing among postsurgical cancer patients. The key findings are: 1. TPS interventions carried out by multidisciplinary teams incorporating biophysical-psychological pain interventions have resulted in successful implementation with improved pain-related patient outcomes, mitigating the occurrence of PPSP. 2. Meta-regression analysis showed that the feasibility of TPS ranged from 77% to 92%, with studies below the median sample size showing higher feasibility rates. This suggests the need for tailored TPS interventions based on the severity and nature of patients' individualized perioperative pain experiences. 3. Subgroup analysis revealed that randomized controlled trials (RCTs) showed a high effectiveness feasibility rate of 99%, while observational studies involving prospective cohorts and mixed cohorts showed feasibility rates of 80% and 79% respectively. This highlights the potential utility of observational studies in identifying patients who may benefit from TPS interventions. 4. TPS involves individualized preoperative pain evaluation, identification of pain catastrophizing, implementation of pain education, and multimodal prehabilitation and early pain coping interventions to modify pain trajectory perioperatively. This comprehensive approach helps bridge the "pain gap" and the "period gap" in the transition from hospital to home care. 5. TPS has shown promise in achieving opioid sparing, with overall opioid prescription reduction from 27.3% to 13.4% among both opioid-naïve and chronic opioid users. Tele-TPS also reduces frequent hospital visits and possesses immense future potential in cancer pain management.

Conclusion

In conclusion, this review highlights the feasibility and effectiveness of TPS interventions in preventing PPSP and pain catastrophizing, with the potential to improve pain-related patient outcomes and achieve opioid sparing. The findings underscore the need for a dedicated TPS to bridge the perioperative pain and period gaps.

Key Points

1. Transitional pain service (TPS) interventions carried out by multidisciplinary teams incorporating biophysical-psychological pain interventions have resulted in successful implementation with improved pain-related patient outcomes, mitigating the occurrence of persistent postsurgical pain (PPSP).

2. Meta-regression analysis showed that the feasibility of TPS ranged from 77% to 92%, with studies below the median sample size showing higher feasibility rates, suggesting the need for tailored TPS interventions based on the severity and nature of patients' individualized perioperative pain experiences.

3. Subgroup analysis revealed that randomized controlled trials (RCTs) showed a high effectiveness feasibility rate of 99%, while observational studies involving prospective cohorts and mixed cohorts showed feasibility rates of 80% and 79% respectively, highlighting the potential utility of observational studies in identifying patients who may benefit from TPS interventions.

4. TPS involves individualized preoperative pain evaluation, identification of pain catastrophizing, implementation of pain education, and multimodal prehabilitation and early pain coping interventions to modify pain trajectory perioperatively, helping to bridge the "pain gap" and the "period gap" in the transition from hospital to home care.

5. TPS has shown promise in achieving opioid sparing, with overall opioid prescription reduction from 27.3% to 13.4% among both opioid-naïve and chronic opioid users, and tele-TPS also reduces frequent hospital visits and possesses immense future potential in cancer pain management.

6. The findings of this review underscore the need for a dedicated TPS to bridge the perioperative pain and period gaps and prevent PPSP and pain catastrophizing, with the potential to improve pain-related patient outcomes and achieve opioid sparing.

Reference –

Thota RS, Ramkiran S, Jayant A, Kumar KS, Wajekar A, Iyer S, et al. Bridging the pain gap after

cancer 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.