Transitional Pain Service for Preventing Chronic Postsurgical Pain: A Scoping Review of Published Literature and Considerations for Research and Practice

Since its introduction, the transitional pain service, a multicomponent perioperative program, has been considered to hold the promise of reducing the risk of chronic postsurgical pain unlike single-modality interventions. This scoping review on the use of transitional pain service or transitional pain service-like programs observed limited and low-quality evidence in the form of fifteen studies (seven retrospective chart reviews, five cohort studies, and only one randomized controlled trial), with only six studies assessing any postoperative pain outcomes and only one assessing postsurgical pain as a secondary outcome. A majority of studies focused on postoperative opioid use, observing important reductions. Along with a comprehensive review of transitional pain service, this study discusses its inherent appeal for reducing chronic postsurgical pain; essential components based on its theoretical foundations and the need to distinguish it from other multimodal perioperative strategies; challenges and limitations; and lastly the need for effectiveness research through pragmatic trials. Despite continuing to be an important outcome, the overall prescription opioid use rate has decreased due to practice and regulatory oversight. Hence, the incentive to convince stakeholders and develop a transitional pain service program based on opioid reduction may not be a viable long-term strategy.