Abstract

BOLIVAR, M et al. Transitional pain clinic. Rev. Soc. Esp. Dolor [online]. 2020, vol.27, n.6, pp.369-374.  Epub Feb 08, 2021. ISSN 1134-8046.  https://dx.doi.org/10.20986/resed.2020.3840/2020.

Persistent postoperative pain is pain that develops after a surgical procedure, which the patient did not present before surgery. It is becoming more and more frequent and a prevalence ranging between 10 % and 50 % of adult patients undergoing major surgery is reported. It should be considered an important public health problem not only because of the anguish and disability it produces, but it may have contributed to the opioid epidemic in the 1980s, and part of the tools used for its treatment may have contributed to this crisis in the United States, by promoting the long-term use of opioids in patients with non-cancer pain.

In order to reduce the severity of postoperative acute pain, a fundamental risk factor involved in the origin of PPP, multidisciplinary approaches are required, aimed at preventing and treating the different risk factors that anticipate this disease. This is how the Transitional Pain Service or Transitional Pain Clinic appears in 2014. It is a novel program that aims to effectively control of acute postoperative acute pain, facilitate opioid weaning, reduce the development of chronic pain disability, and help decrease deaths related to opioid over prescription. This model of care was created to effectively manage patients' perioperative pain, maintain function, reduce opioid use, and monitor the efficacy of these interventions. It focuses on persistent postoperative pain in three stages: 1) pre-operative, 2) post-operative in the hospital setting, 3) post-operative in the outpatient setting up to 6 months after surgery. This program offers services focused on: 1) Introduction and optimization of multimodal analgesia, to improve pain management and facilitate weaning from opioids; 2) Non-pharmacological interventions including physical therapy and acupuncture; and 3) Psychological interventions by a trained pain psychology team, around an acceptance and commitment therapy model.

The new situation we are experiencing with COVID-19 demands innovations in medical care, as non-urgent medical care is reduced or abolished and it is time to look for different options from conventional ones for patient follow-up, it is the time of Telehealth. For now, it is necessary to leverage Video Tele Heath and Transitional Pain Service to continue monitoring our patients.

Keywords : Pain; chronic pain; anaesthesia; perioperative pain treatment; acute pain services; transitional pain services.

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