October 4, 2023
If acute pain after surgery is not managed well — which includes a transitional pain care plan that is put into place for patients as they move from hospital to home — it has a higher chance of leading to chronic postsurgical pain. AHS’ Transitional Pain Services helps prevent acute pain from transitioning into chronic pain, and improves education of acute pain for patients, providers and the public. As well, research is underway at AHS that will ultimately will help Albertans access and better manage pain across their lifespan. Photo supplied.
Story by Korey Cherneski
Pain is something that most people prefer not to experience. It’s felt by everyone throughout their life and, at its root, pain serves an important purpose — to warn of actual or impending tissue damage.
Sometimes, however, acute pain can develop into harmful chronic pain, which can be the case for those who undergo surgery and develop chronic postsurgical pain (CPSP).
If acute pain after surgery is not managed well — which includes a transitional pain care plan that is put into place for patients as they move from hospital to home — it has a higher chance of leading to CPSP.
“For a patient, this can mean moderate to severe postsurgical pain lasting for months or years, negatively affecting their quality of life from a physical, psychological, and social perspective, sometimes resulting in persistent opioid use, with downstream adverse economic and health impacts for the individual, their family and society,” says Dr. Nivez Rasic, AHS anesthesiologist and pain medicine specialist.
In Alberta, access to surgical transitional pain care is limited due to staffing challenges, clinic space, a lack of funding and program availability. But, thanks to a $1.1 million grant from Health Canada’s Substance Use and Addictions Program (SUAP), research is underway to establish a framework that aims to improve access to surgical transitional pain care services across the province.
Together, Dr. Rasic, and Sanjay Beesoon, Assistant Scientific Director with AHS’ Surgery Strategic Clinical Network (SCN) are conducting this research that ultimately will help Albertans access and better manage pain across their lifespan. The study will continue until 2024 and aims to gain insight and expert guidance from researchers and health leaders affiliated with AHS, University of Calgary, University of Alberta, SickKids Hospital, University of Toronto, and University of Washington.
“There is reliable evidence showing that surgical transitional pain services provide a bridge between acute in-hospital pain care and the medical home by providing multidisciplinary care and individualized pain care plans for patients both prior to surgery and for up to six months post-surgery,” says Beesoon.
The incidence of CPSP is 20-30 per cent for people who undergo major surgery, and 10 per cent of all types of surgeries. In Alberta, approximately 270,000 surgeries are performed every year, translating to 27, 000 new cases of CPSP annually.
“These services offer a team-based approach to manage patients who are at risk of developing CPSP to prevent it from occurring and ease its medium and long-term impact,” adds Beesoon.
By using innovative approaches to reduce chronic pain and prevent opioid misuse and opioid use disorder for surgical patients, a framework that is provincial in scope will help improve access to surgical transitional pain care and will support the foundational work that is currently underway, including:
Creating evidence-based screening tools to enable early identification of adult and pediatric patients who are at increased risk of developing CPSP.
Two evidence-based reviews currently underway will generate a list of risk factors for CPSP in adults and children. These reviews will go through further analysis to create brief, targeted questionnaires to identify surgical patients who are most at risk of CPSP. Once identified preoperatively, patients may be offered tailored physical, psychological, and pharmacological treatments to reduce the risk of developing CPSP.
Improving analgesic order sets for inpatients to ensure patients are provided with evidence-based multimodal analgesia.
One known risk factor for CPSP is poorly managed acute postsurgical pain. Various treatments are available to prevent poor acute pain experiences in the hospital. Acute postsurgical pain is best managed with a combination of medications from different drug classes and appropriate anesthesia and surgical interventions. For example, providing regularly scheduled non-opioid medications can improve acute pain management. The SUAP team is also supporting the standardization of Connect Care order sets to ensure evidence-based acute pain practices are widely and easily accessible across the province.
Testing a digital health app to determine whether it can improve pain-related outcomes in surgical patients.
Digital health technologies have gained significant momentum in healthcare. As part of this research, the SUAP team is exploring an opportunity to use a digital application called Manage My Pain to improve patients’ self-management of pain and to connect patients’ self-reported pain experiences directly to their healthcare team. A study is currently underway to examine the impact of this app on pain-related outcomes following spine surgery in Alberta. Findings from this study will be published in 2024.
For more information, or to find out how you can get involved, visit Alberta Pain Strategy | Alberta Health Services.