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Cited by 76Anesthesia and Pain ManagementPain Management and Opioid UsePain Management and Treatment

New approach for treatment of prolonged postoperative pain: APS Out-Patient Clinic

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Tiippana, Elina, Hamunen, Katri, Heiskanen, Tarja, Nieminen, Teija, Kalso, Eija, Kontinen, Vesa K.·2016·Scandinavian Journal of Pain
DOI 10.1016/j.sjpain.2016.02.008
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Abstract

Background and aims: Persistent postoperative pain (PPP) is a significant clinical problem. Several patient-related risk factors for PPP have been identified, including a previous chronic pain problem, young age, female gender and psychological vulnerability. Intra- and postoperative risk factors include surgical complications such as infections, haematoma, nerve damage and repeated surgery. As the length of hospital stay has been shortened, some patients may be discharged despite ongoing pain and insufficient analgesic medication. The challenge is to identify patients at high risk of developing PPP and to create a targeted care pathway to ensure effective and safe pain treatment especially in the subacute postoperative phase at home. This observational study describes the first two years of the Acute Pain Service Out-Patient Clinic (APS-OPC) at the Helsinki University Hospital. Methods: Patient characteristics, known risk factors, and details of treatment of PPP for the first 200 patients referred to our APS-OPC were retrospectively collected from the medical records. The APS-OPC clinic functions in close collaboration with the Multidisciplinary Pain Clinic (MPC), and the number of patients in need of physiotherapist, psychologist or psychiatrist counselling was recorded, as well as the number of patients referred to the MPC for further PPP management. Results: Patients were referred to the APS-OPC from different surgical specialities, the two most common being thoracic and orthopaedic surgery. Seventy per cent of the patients (139/200) presented symptoms indicating neuropathic postsurgical pain. The patients had, on average, five risk factors for PPP. The median time from surgery to the first contact to the APS-OPC was two months, and the median duration of follow-up was 2.8 months (0–16 months). The median number of contacts with APS-OPC was 3 (range 1–14). Every fourth patient needed only one contact to the APS-OPC. Nineteen per cent of the patients had an appointment with the physiotherapist and 20% with a psychologist or psychiatrist. At discharge after surgery, 54% of the patients were using weak opioids, 32% strong opioids and 71% gabapentinoids; at discharge from the APS-OPC, these numbers were 20%, 6% and 43%, respectively. Twenty-two per cent of the patients were referred to the MPC for further pain management. Conclusions: The APS-OPC provides a fluent fast-track method of ensuring effective multimodal analgesia in the subacute recovery phase after surgery. Even strong opioids can be safely used after discharge and then tapered off in close supervision of the APS-OPC anaesthesiologist. As the APS-OPC was implemented in close collaboration with the MPC, the multidisciplinary resources are easily available during the course of the APS-OPC treatment. Implications: The first two years of the APS-OPC have shown that a significant number of surgical patients benefit from continuing active pain management after discharge from hospital. This fast-track service provides physician-supervised titration of analgesics to improve pain relief in the subacute phase. An important task of the APS-OPC is to ensure that strong opioids are not inappropriately continued after recovery. Another goal of the APS-OPC is to identify patients in need of multidisciplinary pain management services to prevent chronification.

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  • A multidisciplinary Acute Pain Service outpatient clinic similar to the Transitional Pain Service reported on a sample of 200 patients after surgery; 54% and 32% were discharged from hospital on weak and strong opioids, respectively, and at the end of the outpatient program 3 months later, 20% and 6% of patients were taking weak and strong opioids.

    “A multidisciplinary Acute Pain Service outpatient clinic similar to the TPS reported on a sample of 200 patients after surgery.71 Fifty-four percent and 32% were discharged from hospital on “weak” and “strong” opioids, respectively. At the end of the outpatient program 3 months later, 20% and 6% of patients were taking weak and strong opioids,”

    From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [71]

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Authors
Tiippana, E., Hamunen, K., Heiskanen, T., Nieminen, T., Kalso, E., & Kontinen, V. K.
Affiliations
University of Helsinki (FI)
Corresponding author
Tiippana, Elina
ORCID
Venue
Scandinavian Journal of Pain
Publisher
Walter de Gruyter GmbH
Published
2016-07-01
Volume
12
Issue
1
Pages
19-24
ISSN
  • 1877-8860 (ISSN-L)
  • 1877-8879
DOI
10.1016/j.sjpain.2016.02.008
OpenAlex
W2299719102
Cited by
76
References
27
Citations by year
2026: 2 · 2025: 6 · 2024: 5 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 12 · 2019: 10 · 2018: 6 · 2017: 7 · 2016: 3
FWCI
9.60
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Scandinavian Journal of Pain (publishedVersion)
  • PubMed (publishedVersion)
Funders
Finnish State funding for university-level health research (TYH2014305)
Topics
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
chronic postoperative pain, outpatient pain clinic, multimodal analgesia, gabapentinoids, opioid analgesics, multidisciplinary pain clinic, physiotherapy, psychological counselling, thoracic surgery, orthopedic surgery, patient satisfaction
MeSH terms
Analgesics, Female, Humans, Male, Outpatients, Pain, Postoperative, Postoperative Pain, Referral and Consultation, Pain Clinics, Pain Management

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