Pain Management Alternatives: Opioid Tapering After Surgery

Clinicians at Toronto General Hospital have been engaging a unique pain program to assist surgical patients in weaning off opioids while still providing pain management alternatives that enhance quality of life. The Transitional Pain Program employs a range of strategies to prevent acute postsurgical pain from becoming chronic pain, to assist in patient risk assessment with respect to opioid use, and to help them taper or wean off opioids safely and effectively. Hance Clarke, MD, PhD, FRCPC, director of the Transitional Pain Service at TG, commented, “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. 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.” Results of a recent study of the program’s effectiveness were published earlier this week in the Canadian Journal of Pain.

The study followed 251 surgical patients at risk for developing chronic postsurgical pain. In patients who did not take opioids prior to their surgery, the Transitional Pain Program helped almost 50% to wean off their opioids. Almost 25% of patients who were taking opioids before surgery were also successful in weaning completely. Among the techniques used by the Pain Program are engagement of nonopioid medications, acupuncture, “exercise prescriptions,” and psychological modalities including mindfulness meditation. Regular communications via phone call and follow-up meetings continue for up to 6 months postprocedure. Dr. Clarke continued, “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.”

Read about the study conclusions.

The journal article may be read here.

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• opioid therapy

• opioids