Loyola University, Baltimore, Maryland, USA.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Scand J Pain. 2022 Dec 27;23(3):613-619. doi: 10.1515/sjpain-2022-0083. Print 2023 Jul 26.
Trauma (i.e., musculoskeletal injury from a blunt or penetrating force) can change the trajectory of a person's life. Patients often experience chronic pain, reduced quality of life, long-term opioid therapy, and psychiatric comorbidities after trauma surgery. This case report presents clinical outcomes of four patients who received postsurgical pain care in a transitional pain service (TPS) that provides long-term coordinated multimodal pain care, opioid tapering plans, and psychiatric care.
The Personalized Pain Program (PPP) measures prescription opioid use and patient-reported outcomes: pain severity and pain interference (Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale), insomnia severity (Insomnia Severity Index), physical and mental health functioning (SF-12 pre-COVID-19; SF-36 during COVID-19 pandemic) at initial and subsequent clinic visits.
All four patients reduced their postsurgical opioid use with concurrent reductions in pain and improved functioning while receiving postoperative care in the PPP (average length of treatment: 2.8 years). Psychiatric co-treatment addressed the onset or exacerbation of mental health comorbidities following trauma.
Long-term multidisciplinary pain care may improve post-trauma recovery and reduce risks of long-term opioid therapy and disability. Prospective studies are needed to evaluate the effectiveness of TPSs for patients undergoing trauma surgery.
创伤（即钝器或穿透性力量造成的肌肉骨骼损伤）可能改变一个人的生活轨迹。患者在创伤手术后经常经历慢性疼痛、生活质量下降、长期阿片类药物治疗和精神共病。本病例报告介绍了在过渡性疼痛服务（TPS）中接受术后疼痛治疗的 4 名患者的临床结果，TPS 提供长期协调的多模式疼痛治疗、阿片类药物减量计划和精神科护理。
个性化疼痛计划（PPP）测量处方阿片类药物的使用和患者报告的结果：疼痛严重程度和疼痛干扰（简明疼痛量表）、疼痛灾难化（疼痛灾难化量表）、失眠严重程度（失眠严重程度指数）、身体和心理健康功能（SF-12 在 COVID-19 之前；SF-36 在 COVID-19 大流行期间）在初始和后续诊所就诊时。
所有 4 名患者在 PPP 中接受术后护理时，减少了术后阿片类药物的使用，同时降低了疼痛和改善了功能（平均治疗时间：2.8 年）。精神科联合治疗解决了创伤后精神共病的发生或恶化。
长期多学科疼痛治疗可能改善创伤后恢复，并降低长期阿片类药物治疗和残疾的风险。需要前瞻性研究来评估 TPS 对接受创伤手术的患者的有效性。
