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

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.

Engagement with Manage My Pain mobile health application among patients at the Transitional Pain Service.

OBJECTIVE: Mobile health platforms have become an important component of pain self-management programs and hundreds of mobile applications are commercially available for patients to monitor pain. However, few of these applications have been developed in collaboration with healthcare professionals or have been critically evaluated. Manage My Pain is a user-driven mobile health platform developed by ManagingLife in collaboration with clinician researchers. Manage My Pain allows patients to keep a "pain record" and supports communication of this information with clinicians. The current report describes a user engagement study of Manage My Pain among patients at the Transitional Pain Service (TPS) at Toronto General Hospital, a multidisciplinary clinic for patients at high risk of developing postsurgical pain. METHODS: Patients at the TPS were encouraged to register on Manage My Pain as one component of a larger, non-randomized prospective study of treatment predictors and treatment enhancement. Uptake of the application and rates of registration, use, and retention were tracked for 90 days. RESULTS: Of the 196 patients who consented to the larger study, 132 (67%) also provided consent to the Manage My Pain component, indicating that they found this to be an acceptable treatment adjunct, and 119 (61%) completed registration. Of those who used the app, 67.9% and 43.2% continued to use Manage My Pain beyond 30 and 90 days, respectively. On average, users engaged with the app for 93.14 days (SD = 151.9 days) logged an average of 47.39 total records (SD = 136.1). CONCLUSIONS: Manage My Pain was found acceptable by a majority of patients at an academic pain management program. Rates of user registration and retention were favorable compared to those reported by other applications. Further research is needed to develop strategies to retain users and maximize patient benefit.