• Reg Anesth Pain Med · Feb 2025

    Review

    Ten years of transitional pain service research and practice: where are we and where do we go from here?

    • Hance Clarke, Anna Waisman, Andrea Aternali, Kristina Axenova, Amjaad Almohawis, Kathryn Curtis, Joseph Fiorellino, Michelle Flynn, Praveen Ganty, Alexander Huang, Zhaorong Hong, Rita Katznelson, Yuvaraj Kotteeswaran, Salima Ladak, Karim S Ladha, Anna Lomanowska, Heather Lumsden-Ruegg, Ala Mahamid, Molly McCarthy, Sarah Miles, Judith Nicholls, M Gabrielle Pagé, Miki Peer, Brittany N Rosenbloom, Santa MinaDanielDDepartment of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada., Rachel Siegal, P Maxwell Slepian, Ainsley Sutherland, Diana Tamir, Leeping Tao, Paul Tumber, Jeffrey Wieskopf, Callon Williams, Elizabeth Woodford, and Joel Katz.
    • Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada hance.clarke@uhn.ca.
    • Reg Anesth Pain Med. 2025 Feb 5; 50 (2): 188203188-203.

    AbstractChronic postsurgical pain (CPSP) is a prevalent yet unintended consequence of surgery with substantial burdens to the individual and their family, the healthcare system, and society at large. The present article briefly reviews the evidence for transitional pain services (TPSs) that have arisen in an effort to prevent and mange CPSP and persistent opioid use, and provides an update on recent novel risk factors for CPSP. Available evidence from one randomized controlled trial (RCT) and three non-randomized cohort studies suggests that TPS treatment is associated with better opioid use outcomes, including fewer opioid tablets prescribed at discharge, better opioid weaning results, a lower incidence of new-onset chronic opioid use, and lower consumption of opioids even at later time points up to 1 year after surgery. Another RCT indicates TPS treatment can be enhanced by provision of perioperative clinical hypnosis. While these preliminary studies are generally positive, large-scale, RCTs are needed to provide a more definitive picture of whether TPSs are effective in reducing opioid consumption and improving pain and mental health outcomes in the short and long term. With the expansion of TPSs across North America and globally, perioperative care focused on reducing the transition to pain chronicity has the potential to help millions of patients. With additional evidence from well-controlled RCTs, TPSs are well poised to continue to evolve and strengthen the role of multidisciplinary care teams in the immediate postdischarge period and beyond.© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

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