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Background and Aims There is published discrepancy in peri-operative outcomes between pre-operative users of strong opioids, and non-users. However, there is a paucity of research assessing the effect of optimising pain management pre-operatively, in patients undergoing bariatric surgery. This study assessed if a novel pre-operative referral pathway for high-risk complex chronic pain patients using strong opioids improves outcomes following weight-reduction surgery.
Methods Patients with chronic pain and strong opioid use awaiting weight-loss surgery were identified by a Bariatric Specialist Nurse, referred to the Plymouth Pain Management Service, and were reviewed by a Consultant in Pain Medicine.
Results Three patients achieved a successful reduction in use of strong opioids; both at hospital discharge and 24-hour post-operative use in these patients. There was no difference in length of hospital in-patient stay between the high-risk chronic pain patient group and the standard patient cohort. A patient feedback questionnaire suggested improved education and understanding of what chronic pain is, a greater awareness of the side effects of opioids, and a positive impact on mental health.
Conclusions Currently only a select few high-risk chronic pain patients have completed the pain pre-operative optimisation pathway. This approach improves patients’ knowledge and understanding of pain management and reduces their chronic use of strong opioids. Further work is needed with increased patient numbers to provide greater insights into how this process could be optimised to provide a better service to patients undergoing weight-loss surgery who suffer with significant chronic pain.
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