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Impact of a Transitional Pain Service on postoperative opioid trajectories: a retrospective cohort study
  1. Karim S Ladha1,2,
  2. Kathak Vachhani1,2,
  3. Gretchen Gabriel1,3,
  4. Rasheeda Darville1,3,
  5. Karl Everett4,
  6. Jodi M Gatley4,
  7. Refik Saskin4,
  8. Dorothy Wong3,
  9. Praveen Ganty1,3,
  10. Rita Katznelson1,3,
  11. Alexander Huang3,
  12. Joseph Fiorellino3,
  13. Diana Tamir3,
  14. Maxwell Slepian3,
  15. Joel Katz3 and
  16. Hance Clarke1,3
  1. 1Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Anesthesia, St Michael’s Hospital, Toronto, Ontario, Canada
  3. 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
  4. 4ICES, Toronto, Ontario, Canada
  1. Correspondence to Dr Hance Clarke, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; hance.clarke{at}


Introduction It has been well described that a small but significant proportion of patients continue to use opioids months after surgical discharge. We sought to evaluate postdischarge opioid use of patients who were seen by a Transitional Pain Service compared with controls.

Methods We conducted a retrospective cohort study using administrative data of individuals who underwent surgery in Ontario, Canada from 2014 to 2018. Matched cohort pairs were created by matching Transitional Pain Service patients to patients of other academic hospitals in Ontario who were not enrolled in a Transitional Pain Service. Segmented regression was performed to assess changes in monthly mean daily opioid dosage.

Results A total of 209 Transitional Pain Service patients were matched to 209 patients who underwent surgery at other academic centers. Over the 12 months after surgery, the mean daily dose decreased by an estimated 3.53 morphine milligram equivalents (95% CI 2.67 to 4.39, p<0.001) per month for the Transitional Pain Service group, compared with a decline of only 1.05 morphine milligram equivalents (95% CI 0.43 to 1.66, p<0.001) for the controls. The difference-in-difference change in opioid use for the Transitional Pain Service group versus the control group was −2.48 morphine milligram equivalents per month (95% CI −3.54 to −1.43, p=0.003).

Discussion Patients enrolled in the Transitional Pain Service were able to achieve opioid dose reduction faster than in the control cohorts. The difficulty in finding an appropriate control group for this retrospective study highlights the need for future randomized controlled trials to determine efficacy.

  • Pain, Postoperative
  • Analgesics, Opioid
  • Pain Management

Data availability statement

No data are available. Not applicable.

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Data availability statement

No data are available. Not applicable.

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  • Twitter @drhaclarke

  • Contributors KSL, KE, JMG, RS, JK and HC conceived the idea for the manuscript and developing the study design. KSL, HC and DW were involved with data collection. KE, RS and JMG analyzed the data. KSL, KV and HC drafted the first version of the manuscript. All authors assisted with reviewing and critically revising the manuscript. HC is responsible for the overall content as the guarantor.

  • Funding This study was Funded by research grants from the province of Ontario Ministry of Health and Long Term Care and by the Substance Use and Addictions Program from the Federal Government of Canada. HC and KSL are funded via a Merit Award from the Department of Anesthesiology and Pain Medicine at the University of Toronto.

  • Disclaimer The analyses, conclusions, opinions and statements expressed here are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

  • Competing interests HC is the president-elect of the Canadian Pain Society.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.