Chronic Opioid Users, Chronic Postsurgical Pain, Perioperative Medicine, Postoperative Pain, Transitional Pain Service
Conditions
Keywords
Chronic postsurgical pain, chronic opioid users, transitional pain service, postoperative pain, perioperative medicine
Brief summary
Chronic opioid users undergoing surgery are at increased risk of CPSP, contributing to long-term disability, decreased quality of life, and prolonged opioid exposure. Existing preventive strategies remain limited, and early postoperative monitoring may represent a key opportunity for intervention. Evidence suggests that transitional pain services can improve outcomes by optimizing pain control and reducing long-term opioid consumption, but implementation is heterogeneous and often resource-intensive. Telemedicine offers a scalable alternative, enabling early specialized evaluation and timely therapeutic adjustments while maintaining accessibility. This randomized controlled trial will compare standard postoperative follow-up with standard follow-up plus a specialized teleconsultation performed between postoperative day 15 and 28. The intervention aims to detect insufficiently controlled pain, signs of neuropathic pain, or maladaptive opioid use, and to propose individualized therapeutic adjustments when required. Participants will be followed for 6 months. Primary assessment will occur at 3 months to determine CPSP incidence. Secondary assessments will include pain trajectory (intensity, neuropathic features, functional interference), opioid consumption and misuse, quality of life, and a descriptive medico- economic evaluation
Interventions
OTHERstandard institutional perioperative management
standard institutional perioperative management
OTHERspecialized teleconsultation
Patients in the intervention arm participate in a specialized teleconsultation between postoperative day 15-28 to detect poorly controlled pain, neuropathic features, or opioid-related concerns, and to adjust treatment if needed.
Sponsors
Centre Hospitalier Universitaire, Amiens
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Elective non-urgent surgery with expected moderate or higher postoperative pain * Chronic preoperative opioid use * Written informed consent * affiliated with a national social security scheme
Exclusion criteria
* Ambulatory surgery * Endoscopic or palliative surgery * Patients receiving opioid substitution therapy * Non-medical opioid use * Intrathecal/epidural analgesia or implanted neurostimulator * Legally protected adults * Severe psychiatric or neurodegenerative disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of chronic postsurgical pain (CPSP) | at 3 months | Incidence of chronic postsurgical pain (CPSP) at 3 months, defined as: * new or aggravated postsurgical pain located at the surgical site or innervated territory, * persistent for ≥3 months, * intensity ≥3/10 (new pain) or increase ≥2/10 from baseline (aggravation), * with significant functional impact (≥3/10 on at least one Brief Pain Inventory interference item), * assessed at day 90 ±14. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain trajectory | at 3 months | Pain trajectory is measured by using intensity (BPI), + neuropathic features (DN4) +Quality of life (EQ-5D-5L) |
| Opioid use | at 3 months | Opioid use is defined as oral morphine equivalent consumption, proportion with reduction/discontinuation, POMI-5F, SOWS, DSM-5 OUD criteria |
| Descriptive medico-economic analysis | at 6 months | Descriptive medico-economic analysis is determined with assessment of direct and indirect costs, descriptive comparison of effectiveness (incidence of CPSP at 6 months),descriptive reporting of utility values derived from EQ-5D-5L at 6 months |
Countries
France
Contacts
CONTACTPaul Tarpin, MD
Outcome results
None listed