Austin Transition Clinic for complex sub-acute pain: opioid weaning and functional recovery

Abstract

Aim: Transitional pain services aim to mitigate the risks of persistent pain, disability, and opioid use after surgery (1). Pain Nurses in the Austin Transition Clinic treat complex patients during the sub-acute period, up to 3 months after hospital discharge. Pain which lasts longer than this is considered persistent (2); however, most patients are discharged from the clinic within one month. We investigated patient outcomes at clinic discharge and at 3-6 months.

Methods: Among patients seen in 2023, we compared routine audit data (n=110), with a cohort followed up at 3-6 months (n=47) using chi-squared and Wilcoxon rank-sum tests; and change in opioid doses from baseline using Signed-Rank tests. Follow-up data was sourced from a quality improvement pilot survey, and the Austin Orthopaedic Clinical Quality Registry, both of which assessed function using the EQ-5D-5L.

Results: At 3-6 months, more than half the survey patients had ongoing pain, with moderate limitations in mobility, usual activities and sleep. However, 75-100% rated these as equal or improved from baseline, and 37% attributed pain to other causes. One in three patients were readmitted to hospital within 90 days. Patients rated their overall health a median of 60 [50-80] out of 100. Median [IQR] oral morphine equivalent daily doses (oMEDD) were reduced from baseline to clinic discharge (45mg [15-80] to 30mg [0-60], p<0.01), and further reduced at follow up (20mg [4-45], p<0.01).

Conclusion: These results demonstrate that despite complex multifactorial pain conditions, patients seen in Transition clinic rarely develop new persistent pain. Patients progressively reduce opioids and regain function. Austin Transition Clinic nurses effectively support patients with complex pain during the sub-acute period after a hospital admission to manage pain and contain opioids as they recover.