Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service

• Published in: Canadian journal of pain Vol. 1; no. 1; pp. 37 - 49
• Main Authors: Abid Azam, Muhammad, Weinrib, Aliza Z., Montbriand, Janice, Burns, Lindsay C., McMillan, Kayla, Clarke, Hance, Katz, Joel
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2017; Taylor & Francis Ltd
• Subjects: acceptance and commitment therapy; Anxiety; anxiété; catastrophisation de la douleur; chronic postsurgical pain; depression; douleur post-chirurgicale chronique; dépression; interférence de la douleur; mindfulness; multidisciplinary pain management; Narcotics; Original; Pain; pain catastrophizing; pain interference; persistent opioid use; pleine conscience; pain interference; anxiety; chronic postsurgical pain; mindfulness; multidisciplinary pain management; persistent opioid use; pain catastrophizing; acceptance and commitment therapy; depression
• ISSN: 2474-0527; 2474-0527
• DOI: 10.1080/24740527.2017.1325317

Background: Chronic postsurgical pain (CPSP) and associated long-term opioid use are major public health concerns. Aims: The Toronto General Hospital Transitional Pain Service (TPS) is a multidisciplinary, hospital-integrated program developed to prevent and manage CPSP and support opioid tapering. This clinical practice-based study reports on preliminary outcomes of the TPS psychology program, which provides acceptance and commitment therapy (ACT) to patients at risk for CPSP and persistent opioid use. Methods: Ninety-one patients received ACT, whereas 252 patients did not (no ACT group). Patient outcomes were compared for the two groups at first and last TPS visits. Pain, pain interference, sensitivity to pain traumatization, pain catastrophizing, anxiety, depression, and opioid use were analyzed using two-way (Group [ACT, no ACT] × Time [first, last visit]) analyses of variance (ANOVAs). Results: Patients referred to ACT were more likely to report a mental health condition preoperatively (P < 0.001), had higher opioid use (P < 0.001) at the first postsurgical visit, and reported higher sensitivity to pain traumatization (P < 0.05) and anxiety (P < 0.05) than the no ACT group at both time points. Both groups showed reductions in pain, pain interference, pain catastrophizing, anxiety, and opioid use by the last TPS visit (P < 0.05). The ACT group demonstrated greater reductions in opioid use and pain interference and showed reductions in depressed mood (P = 0.001) by the end of treatment compared to the no ACT group. Conclusion: Preliminary outcomes suggest that ACT was effective in reducing opioid use while pain interference and mood improved.