Breaking News
February 18, 2019 - Researchers report progress in the treatment of aggressive brain tumors
February 18, 2019 - Scientists discover trigger that turns strep infections into devastating disease
February 18, 2019 - Scanning children’s teeth may predict future mental health issues
February 18, 2019 - Health Highlights: Feb. 14, 2019
February 18, 2019 - New knowledge could help predict and prevent depression
February 18, 2019 - More primary care physicians leads to longer life spans | News Center
February 18, 2019 - Patented IU discovery to treat ARDS has been optioned to Theratome Bio
February 18, 2019 - Male Y chromosomes not ‘genetic wastelands’
February 18, 2019 - Hormone therapy during gender transition may increase risk for cardiovascular events
February 18, 2019 - NICE renews accreditation for Advanced
February 18, 2019 - FDA Grants Orphan Drug Designation to Amplyx Pharmaceuticals for APX001 for Treatment of Cryptococcosis
February 18, 2019 - Molecule effective in killing tuberculosis bacteria
February 18, 2019 - Columbia researchers unravel why some glioblastomas respond to immunotherapy
February 18, 2019 - Men who are able to do ten push-ups are less likely to have a stroke
February 18, 2019 - Blood-brain barrier disruption could lead to age-related cognitive decline
February 18, 2019 - Combination of PARP inhibitor and immunotherapy results in tumor regression in SCLC mouse models
February 18, 2019 - Heavy smoking could lead to vision loss, study finds
February 18, 2019 - New diagnostic test for malaria uses spit, not blood
February 18, 2019 - New therapeutic molecules show promise in reversing memory loss related to depression, aging
February 18, 2019 - Darla Shine joins anti-vaccination campaigners
February 18, 2019 - New study outlines sex-specific issues in ischemic heart disease
February 18, 2019 - Drug combinations could become first-line treatment for metastatic kidney cancer
February 18, 2019 - Lifetime adversity, increased neural processing during trauma combine to intensify core PTSD symptoms
February 18, 2019 - HRQoL Scores Decrease With Treatment Line in Multiple Myeloma
February 18, 2019 - Convincing evidence that type 2 diabetes is a cause of erectile dysfunction
February 18, 2019 - Study offers implications of advanced age in evaluation, management of ischemic heart disease
February 18, 2019 - Children from homes with flame-retardant sofa have high SVOC concentration in their blood
February 18, 2019 - Art Institute of Chicago announces results of research on five terracotta sculptures
February 18, 2019 - New PET/CT tracer shows high detection rate for diagnosis of acute venous thromboembolism
February 18, 2019 - Smoking may blight immune response against melanoma and reduce survival
February 18, 2019 - How Inactivity and Junk Food Can Harm Your Brain
February 18, 2019 - Diabetes tops common conditions for frequent geriatric emergency patients
February 18, 2019 - Longer-lived sperm produces offspring with healthier lifespans
February 18, 2019 - New dental adhesive prevents tooth decay around orthodontic brackets
February 18, 2019 - New eHealth tool shows potential to improve quality of asthma care
February 18, 2019 - New Australian initiative helps emergency clinicians to improve patient care
February 17, 2019 - Apellis Pharmaceuticals’ APL-2 Receives Fast Track Designation from the FDA for the Treatment of Patients with Paroxysmal Nocturnal Hemoglobinuria
February 17, 2019 - Researchers identify faulty ‘brake’ that interferes with heart muscle’s ability to contract and relax
February 17, 2019 - Support from trusted adults can reduce risk of dying in suicidal teens, finds study
February 17, 2019 - Heart attack awareness improved since 2008
February 17, 2019 - Exercise gives a better brain boost to older men than women
February 17, 2019 - New research disproves previous assumptions of how looks influence personality
February 17, 2019 - Cannabis use as a teenager linked to depression later in life
February 17, 2019 - Sinks by Toilets in ICU Patient Rooms Harbor Harmful Bacteria
February 17, 2019 - Cancer cells’ plasticity makes them harder to stop
February 17, 2019 - Young cannabis users have increased risk of depression and suicidal behavior
February 17, 2019 - Tasmanian Devils Likely to Survive Cancer Scourge
February 17, 2019 - Neoadjuvant PD-1 blockade seems effective in glioblastoma
February 17, 2019 - Personal, social factors play role in enabling sustainable return to work after ill health
February 17, 2019 - Mouse studies show ‘inhibition’ theory of autism wrong
February 17, 2019 - Study shows how neuroactive steroids inhibit activity of pro-inflammatory proteins
February 17, 2019 - Use of liver grafts from older donors decreased despite better outcomes in recipients
February 17, 2019 - MUSC researchers discover new mechanism for a class of anti-cancer drugs
February 17, 2019 - HPV misconceptions are causing women to miss smear tests
February 17, 2019 - Sanofi and Regeneron Offer Praluent (alirocumab) at a New Reduced U.S. List Price
February 17, 2019 - Researchers say auditory testing can identify children for autism screening
February 17, 2019 - New method analyzes how single biological cells react to stressful situations
February 17, 2019 - WVU gynecologic oncologist investigates novel treatment for cervical and vaginal cancers
February 17, 2019 - ADHD diagnoses poorly documented
February 17, 2019 - Majority of gender minority youth do not identify with traditional sexual identity labels
February 17, 2019 - AbbVie, Teneobio enter into strategic transaction to develop potential treatment for multiple myeloma
February 17, 2019 - Lower Birth Weight May Up Risk for Psychiatric Disorders
February 17, 2019 - Scientists identify reversible molecular defect underlying rheumatoid arthritis
February 17, 2019 - Moffitt researchers shed light on how CAR T cells function mechanistically
February 16, 2019 - Female Anatomy May Play Big Role in Sperm’s Success
February 16, 2019 - BMI may mediate inverse link between fiber intake, knee OA
February 16, 2019 - Movement impairments in autism can be reversed through behavioral training
February 16, 2019 - Studies address racial disparities in postpartum period and cardiovascular health
February 16, 2019 - Scientists implicate hidden genes in the severity of autism symptoms
February 16, 2019 - Decreased deep sleep linked to early signs of Alzheimer’s disease
February 16, 2019 - Neuroscientists show how the brain responds to texture
February 16, 2019 - Gilead Announces Topline Data From Phase 3 STELLAR-4 Study of Selonsertib in Compensated Cirrhosis (F4) Due to Nonalcoholic Steatohepatitis (NASH)
February 16, 2019 - What Can I Do About Sweating? (for Teens)
February 16, 2019 - Companies navigate dementia conversations with older workers
February 16, 2019 - Newly developed stem cell technologies show promise for treating PD patients
February 16, 2019 - Collaborative material research could advance self-assembling nanomaterials
February 16, 2019 - Researchers take major step in creating technology that mimics the human brain
February 16, 2019 - Erasing memories associated with cocaine use reduces drug seeking behavior
February 16, 2019 - Artificial intelligence can accurately predict prognosis of ovarian cancer patients
February 16, 2019 - Racial disparities in cancer deaths on the decline for America
Unique pain program helps surgical patients wean off opioids safely and effectively

Unique pain program helps surgical patients wean off opioids safely and effectively

image_pdfDownload PDFimage_print

A unique pain program is helping complex surgical patients wean off opioids safely and effectively, while offering alternative ways to cope with their pain and improve how they function.

A study following 251 surgical patients at risk of developing chronic pain or persistent opioid use at Toronto General Hospital (TG), University Health Network (UHN) found that almost half of patients who did not take opioids before surgery were able to wean off opioids, and one in four of those who did take opioids before surgery were able to wean completely.

Prescription opioids play an important role in addressing certain kinds of pain – they are the best pharmacological option available for acute pain and widely used for cancer-related pain.

But the high overall rate of opioid prescribing in Canada has raised concerns, and prescribing in the context of non-cancer pain has been called into question. Health Quality Ontario and the Canadian Pain Society have created guidelines indicating opioids should not be considered the first line of defense in non-cancer pain.

Results are published in the Canadian Journal of Pain on August 20, 2018 under the title, “Opioid Weaning and Pain Management in Post-Surgical patients at the Toronto General Hospital Transitional Pain Service.”

The study followed patients at high-risk for developing chronic pain and problematic opioid use for six months after surgery. In patients who did not take opioids for a year before surgery, the study found that 69 per cent were able to reduce their opioid consumption, with 45 per cent of them being able to stop completely.

Those patients who were taking a prescription opioid before surgery reduced their opioid use by 44 per cent, with 26 per cent of them weaning off completely.

“The assumption is that all patients after surgery are fine with their opioid use, but we have found that in a high-risk segment of patients, that is not the case,” says Dr. Hance Clarke, Director of the Transitional Pain Service at TG. “We need better ways of identifying these patients, and then helping those who are having difficulty in reducing or eliminating their opioid use.”

“Otherwise, we run the risk of de-escalating patients too fast and having them look elsewhere for opioids or other drugs if we don’t guide them.”

A 2016 study on the Transitional Pain Program at TG estimated that about 15 per cent of complex postoperative pain patients develop moderate to severe chronic, post-surgical pain, have significant disability and continue to use opioids for pain relief long-term.

Follow-up for the surgical patients referred to the Transitional Pain Program in this study included a phone call within 72 hours after surgery and follow-up meetings twice a month initially, and then monthly from three to six months. The goal is to prevent acute pain from becoming chronic post-surgical pain and taper opioid use or wean to zero if possible.

The Transitional Pain Program at TG uses a variety of methods to help and teach patients to manage their pain. These include prescribing non-opioid medications, use of psychological techniques, such as mindfulness or moment-by-moment awareness of our thoughts and sensations, as well as “exercise prescriptions” and acupuncture by a team of pain specialists, including physicians, nurses, psychologists, and physiotherapists.

The program also provides much-needed support for patients and primary care physicians after hospital discharge.

Sheldon Fine, 67, who is a medical oncologist in Peel Region, had thoracic surgery to remove a huge benign mass on his right lung in 2017. Because of the pain after his hospital discharge, he found himself on a daily dose of 120 milligrams of hydromorphone, a strong opioid that is five times more powerful than morphine.

With the help of the Transitional Pain Program at TG, his family and a strong desire to get off the opioid, he was able to taper down to 5 milligrams a day within five weeks, and eventually was able to get off the opioid completely.

Today, he runs marathons with his daughters and is back at work full-time.

“It was team work,” he says. “The program involves patients every step of the way and sets milestones with them. They use different techniques such as physiotherapy and mindfulness training and the staff are so responsive to a patient’s concerns and questions.”

One of the strongest predictors in the study of remaining on opioids long-term after hospital discharge is the dose upon discharge: the higher the dose, the more likely the patient will remain on opioids long-term.

For patients who were on opioids before surgery, emotional distress factors such as anxiety or depression, and pain catastrophizing – excessive pain-related worry, along with an inability to deflect thoughts from pain – were important factors in how well these patients could wean off opioids.

A 2017 study on the Transitional Pain Program of post-surgical patients showed that a combined approach of mindfulness meditation along with specific psychological coping skills helped patients wean off high-doses of opioids and reduce their pain-related distress and disability.

“Identifying at-risk patients, typically those who have pre-existing pain, mental health issues, chronic use of opioids before surgery, is critical, so that we can develop follow-up plans, and educate patients and other healthcare clinicians,” says Dr. Clarke, who is also the Medical Director of the Pain Research Unit at TG.

“We need to give patients the tools to manage their pain. Our clinical work and research suggests there is a powerful role for interventions other than opioids in helping patients manage their pain and suffering, taper their opioids and lead rich, meaningful lives.

“Our program is a good blueprint that we can use not only for surgical patients, but for anyone else dealing with an opioid addiction.”

According to Public Health Ontario, here has been a steady increase in opioid-related harms in Ontario for more than a decade. Since 2003, the number of deaths has increased 136 per cent; more than 850 Ontarians died from opioid-related causes in 2016.

A 2017 report from the Institute for Clinical Evaluative Sciences (ICES), St. Michael’s Hospital and the Ontario Drug Policy research Network (ODPRN) found that opioid-related deaths are occurring among all ages, incomes and in both sexes – making it a widespread public health challenge.

A 2018 Health Quality Ontario Report found that surgeons in Ontario prescribed “new starts” of opioids to 265,643 patients in one year, and that eight per cent were above 90 mg of morphine equivalent (MEQ). (Family physicians prescribed “new starts” of opioids to 577,533 patients, with 1.7 per cent more than 90 MEQ, and dentists prescribed “new starts” to 219,853 patients, with 0.7 per cent more than 90 MEQ in the same time frame.)

The report notes that starting a patient on a dose of opioids higher than 90 MEQ has been shown to increase the risk of death from opioid poisoning relative to starting on a low dose.

“For a sub-population of patients who struggle with pain disability after surgery, it is important that we support them with appropriate pharmacological and non-pharmacological strategies,” says Dr. Clarke, adding that the Transitional Pain Program at TG has developed non-opioid options in the treatment of chronic pain which should also be considered, consistent with Health Quality Ontario standards.

Tagged with:

About author

Related Articles