1. Psychological Service Usage Predicts Decline in Opioid Consumption in Complex Surgery Patients Referred to the Transitional Pain Service
M A Azam, MSc1,2, A Weinrib, PhD1,2, J Montbriand1,2, R Katznelson1, K McRae1, D Tamir1, S Lyn1, K McMillan1,
J Katz, PhD 1,2 & H Clarke MD PhD 1
1Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Ontario
2Department of Psychology, York University, Toronto, Ontario
Background
Methods
Opioid medication is a first line of treatment for postsurgical pain. However, opioid misuse is a growing concern with sharply rising rates of addiction1 and mortality2.
The Toronto General Hospital Transitional Pain Service (TPS)3 helps complex patients undergoing surgery wean off opioids by accessing psychological services that teach behavioural management skills.
This study was approved by the University Health Network Research Ethics Board. Written informed consent was obtained at TPS intake, and no financial compensation was given to participants. Data were collected, maintained and analyzed by the Pain Research Unit at the Toronto General Hospital, Toronto, Canada. Opioid consumption data was available for 143 patients (81M, 62F, age=51.0 years, SD=14.46). A total of 68 patients were referred to and assessed for psychological services; n=36 received multiple (˃2) sessions (multiple session users), n=32 only received assessment or assessment plus a single session (single session users), and n=75 were not referred for psychological services (non-referred). Average pain intensity was reported using an 11-point NRS at each follow up visit to the TPS after hospital discharge. Opioid consumption was calculated as total morphine equivalent dose (MEQ), and standardized residual change scores were calculated based on in-hospital postoperative (log) MEQ and last TPS visit MEQ (median=3 months postop) values. One-way ANCOVA tested effects of psychological service usage on residualized MEQ scores using average pain at last TPS visit as a covariate.
Purpose
Results
Average pain intensity at last TPS visit did not differ between multiple session users (Mpain=4.59, SD=2.63), single-session users (Mpain=5.06, SD=2.38), and non-referred (Mpain=4.59, SD=2.42). ANCOVA revealed a significant main effect of psychological services on MEQ, controlling for average pain at last TPS visit (F(2, 142)=5.05, p<.01). Post-hoc comparisons indicated MEQ change (reduction) in multiple session users and non-referred was significantly greater (p<.05) in comparison to single-session users.
We compared opioid consumption and weaning in TPS patients who differed in their use of, and need for, psychological services.
References
1.Garland EL, et al. (2014). Neurosci Biobehav Rev; 37(10):2597–607.
2.Dhalla I a., et al. (2009) Cmaj; 181(12):891–6.
3.Katz J, et al. (2015) J Pain Res; 8:695–702.
Conclusion
These preliminary data suggest greater uptake of TPS psychological services in appropriate patients would improve postsurgical opioid weaning.
*H Clarke is supported by a Merit Award, UofT, Department of Anesthesia; M A Azam is supported an Ontario Graduate Scholarship. J Katz is supported by a Canadian Institutes of Health Research Canada Research Chair in Health Psychology