The Role of a Transitional Pain Approach to Surgical Care in a Patient With an Opioid Use Disorder: A Case Report.

Abstract

Introduction: The management of postoperative pain in patients with an opioid use disorder (OUD) is challenging. Hospitals are frequently not equipped to respond effectively to the pain of these patients following surgery. For example, many caregivers are reluctant to prescribe opioids to these patients because a relapse in their misuse of drugs may occur. Limited research is available on the management of pain in this population, particularly in relation to the transition from the hospital to the community.

Case report: A 28-year-old male with a long-standing OUD requiring cardiothoracic surgery to remove a right atrial myxoma was admitted to the hospital. He transitioned from intravenous heroin and fentanyl use to a stable dose of methadone to manage his addiction in anticipation of surgery. In collaboration with the Acute Pain Service, an addiction nurse coordinator, along with an interprofessional team, developed a transitional pain management plan (TPMP) in order to coordinate his care throughout the perioperative period and beyond discharge.

Discussion: Concepts to the TPMP were as follows: continuous interaction with a hospital-based addiction nurse coordinator, involvement of an acute pain specialist, a nonjudgmental approach to the patient, continuous teaching regarding his care, ensuring that caregivers worked within the TPMP, and interaction with a community-based addiction specialist.

Conclusion: Given that this patient's OUD (a) was controlled during his hospitalization, (b) his pain was effectively managed, and (c) he transitioned to an addiction specialist in the community upon discharge, it appears that this intervention, the development and use of a TPMP, was successful.