Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service

Hai Chuan Yu; Valery Kleiman; Katarina Kojic; P Maxwell Slepian; Henry Cortes; Karen McRae; Rita Katznelson; Alex Huang; Diana Tamir; Joseph Fiorellino; Praveen Ganty; Nathalie Cote; Michael Kahn; Istvan Mucsi; Nazia Selzner; Dmitry Rozenberg; Cecilia Chaparro; Vivek Rao; Marcelo Cypel; Anand Ghanekar; Sharath Kona; Stuart McCluskey; Salima Ladak; Daniel Santa Mina; Keyvan Karkouti; Joel Katz; Hance Clarke

doi:10.1097/TP.0000000000004441

Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service

Transplantation. 2023 Jun 1;107(6):1398-1405. doi: 10.1097/TP.0000000000004441. Epub 2022 Dec 9.

Authors

Hai Chuan Yu^{1

2}, Valery Kleiman^{1

2}, Katarina Kojic^{3

4}, P Maxwell Slepian^{1

2

5

6}, Henry Cortes^{1

2}, Karen McRae^{1

2

5}, Rita Katznelson^{1

2

5}, Alex Huang^{1

2

5}, Diana Tamir^{1

2

5}, Joseph Fiorellino^{1

2

5}, Praveen Ganty^{1

2}, Nathalie Cote^{1

2}, Michael Kahn^{1

2

5}, Istvan Mucsi⁷, Nazia Selzner⁷, Dmitry Rozenberg⁸, Cecilia Chaparro^{9

10}, Vivek Rao^{11

12

13

14}, Marcelo Cypel¹⁵, Anand Ghanekar⁷, Sharath Kona^{1

2}, Stuart McCluskey^{1

2

5}, Salima Ladak^{1

2

5}, Daniel Santa Mina^{1

2

5}, Keyvan Karkouti^{1

2

5

16}, Joel Katz^{1

2

5

6

17}, Hance Clarke^{1

2

5

17}

Affiliations

¹ Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
² Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
³ Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
⁴ Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada.
⁵ Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Department of Psychology, York University, Toronto, ON, Canada.
⁷ Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada.
⁸ Temerty Faculty of Medicine, Division of Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
⁹ Division of Respirology, Department of Medicine, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁰ Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada.
¹¹ Peter Munk Cardiac Centre of the University Health Network, Toronto, ON, Canada.
¹² Ted Rogers Centre for Heart Research, Toronto, ON, Canada.
¹³ University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Cardiovascular Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
¹⁵ Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada.
¹⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹⁷ University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.

PMID: 36482750
DOI: 10.1097/TP.0000000000004441

Abstract

Background: With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants.

Methods: In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen.

Results: Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption.

Conclusions: Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.

MeSH terms

Adult
Analgesics, Opioid / therapeutic use
Hospitals, General
Humans
Opioid-Related Disorders* / prevention & control
Organ Transplantation*
Pain, Postoperative / prevention & control
Quality of Life
Retrospective Studies

Substances

Analgesics, Opioid