Transitional Pain Service
Postoperative pain is aggressively managed in acute settings. On the contrary, little attention has been given to persistent postoperative pain. Unfortunately, the prevalence of persistent postoperative pain remains problematic, with at least half of patients reporting moderate to severe pain at the time of discharge.1 These shortfalls can be attributed to a multitude of factors, including the absence of transitional pain care among most health systems across the world.
Subacute or transitional pain services should be the standard of care rather than a luxury.
The main focuses of the perioperative anesthesiologist are providing effective analgesia during surgical procedures and simultaneously striving to impact reductions in long-term (chronic/persistent) postoperative pain. However, few resources and clinical guidance are directed at supporting patients during the subacute postoperative period. Unfortunately, the majority of hospitals and health systems across the world have poorly developed practices for the post discharge period, such as prescribing opioids, which further contribute to the opioid crisis.
When developing clinical services and supporting research programs, collaboration of multidisciplinary team members, supporting policies, and finances of subacute/transitional care are somewhat different than those required for the acute and chronic pain services. Subacute or transitional pain services should be the standard of care rather than a luxury.
There are many potential challenges to the establishment of new subacute or transitional pain services:
- Obtaining approval from institutional leadership
- Structure, staffing, organization, and management
- Collaboration of acute and chronic care
- Marketing newly available services
- Financial aspects and funding
- Follow-up quality and other outcomes
- Service maintenance, financial projections, and future directions.
The creation of a Persistent Perioperative Pain (Transition from Acute to Chronic Pain) Special Interest Group (SIG) created a platform for ASRA members with an interest in this area to network and collaborate. There is also a critical need to develop educational curriculum in both acute and chronic pain fellowships on this topic. The SIG is working to develop clinical guidelines on, advocate for, and support research addressing these unmet needs. Our SIG aims to improve and disseminate the knowledge, education, and research related to the management of transitional pain.
Supporting evidence is necessary for creating guidelines for this novel service. We have summarized experience from multiple centers that have established transitional pain services to guide others pursuing the same goal:
Hesham Elsharkawy, MD, MBA, MSc, FASA, is an associate professor of Anesthesiology at Case Western Reserve University, University, MetroHealth Pain and Healing Center in Cleveland, OH.
- Richebé P, Capdevila X, Rivat C. Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology. 2018 Sep;129(3):590-607. doi: 10.1097/ALN.0000000000002238. PMID: 29738328.