A case report on the treatment of complex chronic pain and opioid dependence by a multidisciplinary transitional pain service using the ACT Matrix and buprenorphine/naloxone

In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidi...

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Bibliographic Details
Published inJournal of pain research Vol. 10; pp. 747 - 755
Main Authors Weinrib, Aliza Z, Burns, Lindsay C, Mu, Alex, Azam, Muhammad Abid, Ladak, Salima Sj, McRae, Karen, Katznelson, Rita, Azargive, Saam, Tran, Cieran, Katz, Joel, Clarke, Hance
Format Journal Article
LanguageEnglish
Published New Zealand Dove Medical Press Limited 01.01.2017
Taylor & Francis Ltd
Dove Medical Press
Subjects
Anesthesiology
Case Report
Case studies
Child development
Chronic pain
Development and progression
Drug therapy
Fibromyalgia
Hospitals
multidisciplinary pain treatment
Narcotics
opioid dependence
Pain management
Patients
Peripheral neuropathy
Psychology
Substance abuse treatment
Surgery
Systematic review
Ulcers
Weaning
Canada
chronic pain
transitional pain service
acceptance and commitment therapy
opioid weaning
postsurgical pain
opioid dependence
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Summary:In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidisciplinary care of a complex, postsurgical pain patient by an innovative transitional pain service (TPS). A 59-year-old male with complex chronic pain, as well as escalating long-term opioid use, presented with a bleeding duodenal ulcer requiring emergency surgery. After surgery, the TPS provided integrated pharmacological and behavioral treatment, including buprenorphine combined with naloxone and acceptance and commitment therapy (ACT) using the ACT Matrix. The result was dramatic pain reduction and improved functioning and quality of life after 40+ years of chronic pain, thus changing the pain trajectory of a chronic, complex, opioid-dependent patient.
ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S124566