2021 年 36 巻 2 号 p. 109-116
Chronic postsurgical pain (CPSP), an often unanticipated result of necessary and even life–saving procedures, develops in 5–10% of patients one–year after major surgery. Sub–stantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder–like symptoms. Toronto General Hospital (TGH) is the first to comprehensively address the problem of CPSP. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Transitional pain service (TPS) has been effective in safely weaning patients from opioids in the postoperative period, in both opioid naive and experienced patients. At the same time, TPS involvement in the post–discharge period has also led to reductions in reported pain. With the increasing availability and adoption of mobile technology, the TPS has recently engaged patients in self–reporting of pain scores and functioning through mobile applications. This facilitates ongoing tracking and documentation, and allows patients to participate in their pain management more actively. The future of pain management must involve providing support and expertise to allow for the development of similar programs at other hospitals, allowing easier access for patients in need.
