Reducing Opioid Use for Chronic Pain Patients Following Surgery

Summary

Patients with chronic pain are often prescribed long-term opioid therapy, despite the serious risks and growing concerns related to opioid use. The Toronto General Hospital has created the world's first multidisciplinary perioperative Transitional Pain Service Program (TPSP) aimed at reducing the incidence and severity of chronic post-surgical pain. The TPSP incorporates a variety of mechanisms and interventions to help patients manage pain and to wean off opioids. The approach consists of: pain education, Acceptance and Commitment Therapy (ACT), and an e-mobile self- management tool to help patients manage chronic pain more effectively. With the TPSP team, the investigators hope to continually assist patients to achieve a balance between the benefits and potential harms of opioid use to promote long-term health and well-being.

Conditions

• Chronic Pain
• Opioid Use
• Postoperative Pain
• Opioid Dependence

Interventions

OTHER

Interventional Group

The Transitional Pain Service Program enables targeted, mechanism-based, treatment innovations aimed at reducing the incidence and severity of chronic post-surgical pain, disability and enabling safe opioid prescribing/ weaning after major surgery. The investigator's TPSP intervention uses a variety of methods to support patients to manage pain and wean off opioids. This includes physician-guided opioid and non-opioid pharmacotherapy and tapering, and clinical psychology services specializing in pain education, Acceptance \& Commitment Therapy (ACT) and e-mobile self-management tools.

OTHER

Control Intervention

Patients in the control group will receive standard care, which involves standard postoperative follow-up with their surgeon/primary care provider. Patients will also be sent with a link for an online multimedia tool during each follow-up time point that will provide information and education regarding non-pharmacologic techniques for managing pain. At the end, all patients in the control arm will be invited to join the TPSP after one year of follow-up if they are still taking opioids.

Sponsors & Collaborators

• University Health Network, Toronto

  lead OTHER

Principal Investigators

• Karim Ladha, MD · Toronto General Hospital, University Health Network

• Hance Clarke, MD, PhD · Toronto General Hospital, University Health Network

• Elaheh Adly, MD · Hamilton Health Sciences Centre

• Paul Tumber, MD · University Health Network, Toronto

• Anton Marinov, MD · Rouge Valley Medical Centre

• Melanie Toman, MD · Thunder Bay Reginal Health Sciences Centre

• Yuvaraj Kotteeswaran, MD · Thunder Bay Reginal Health Sciences Centre

• Duminda Wijeysundera, MD · Unity Health Toronto

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-10-15

Primary Completion

2026-12-31

Completion

2026-12-31

Countries

• Canada

Study Locations