{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:19:16Z","timestamp":1790050756105,"version":"4.0.1"},"reference-count":30,"publisher":"BMJ","issue":"11","funder":[{"name":"Veterans Affairs Office of Rural Health"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR002538"],"award-info":[{"award-number":["UL1TR002538"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Veterans Affairs Center of Innovation"},{"name":"Veterans Affairs Whole Health Initiative"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,7,25]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Chronic postsurgical pain and opioid use is a problem among patients undergoing many types of surgical procedures. A multidisciplinary approach to perioperative pain management known as a transitional pain service (TPS) may lower these risks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective cohort study was conducted at the Salt Lake City VA Medical Center to compare patients undergoing elective primary or revision total knee, hip, or shoulder replacement or rotator cuff repair in the year before (2017) and after (2018) implementation of a TPS. The primary outcome is the proportion of patients taking opioids 90 days after surgery. Secondary outcomes include new chronic opioid use (COU) after surgery as well as the proportion of previous chronic opioid users who stopped or decreased opioid use after surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At 90 days after surgery, patients enrolled in TPS were significantly less likely to be taking opioids (13.4% TPS vs 27.3% pre-TPS; p=0.002). This relationship remained statistically significant in a multivariable logistic regression analysis, where the TPS group had 69% lower odds of postoperative COU compared with the preintervention group (OR: 0.31; 95% CI: 0.14 to 0.66; p=0.03). Opioid-naive patients enrolled in TPS were less likely to have new COU after surgery (0.7% TPS vs 8.4% pre-TPS; p=0.004). Further, patients enrolled in TPS with existing COU prior to surgery were more likely to reduce or completely stop opioid use after surgery (67.5% TPS vs 45.3% pre-TPS; p=0.037) as compared with pre-TPS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These data suggest that a TPS is an effective strategy for preventing new COU and reducing overall opioid use following orthopedic joint procedures in a Veterans Affairs hospital.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-101797","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T02:30:34Z","timestamp":1598495434000},"page":"847-852","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service"],"prefix":"10.1136","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-1461","authenticated-orcid":false,"given":"Michael J","family":"Buys","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA"},{"name":"Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberlee","family":"Bayless","sequence":"additional","affiliation":[{"name":"Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Romesser","sequence":"additional","affiliation":[{"name":"Psychology, VA Salt Lake City Health Care System Mental Health Services, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Anderson","sequence":"additional","affiliation":[{"name":"Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shardool","family":"Patel","sequence":"additional","affiliation":[{"name":"Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela P","family":"Presson","sequence":"additional","affiliation":[{"name":"Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin S","family":"Brooke","sequence":"additional","affiliation":[{"name":"Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA"},{"name":"Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,8,26]]},"reference":[{"key":"2025101111224132000_45.11.847.1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-4248-7"},{"key":"2025101111224132000_45.11.847.2","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000319"},{"key":"2025101111224132000_45.11.847.3","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2217\/pmt-2016-0004","article-title":"Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service","volume":"6","author":"Huang","year":"2016","journal-title":"Pain Manag"},{"key":"2025101111224132000_45.11.847.4","doi-asserted-by":"crossref","DOI":"10.1097\/00003643-201206001-00011","article-title":"Chronic post-surgical pain after herniorrhaphy, hysterectomy and thoracotomy: incidence of pain at 3 and 12 months. GENDOLCAT study","volume":"29","author":"Montes","year":"2012","journal-title":"Eur J Anaesthesiol"},{"key":"2025101111224132000_45.11.847.5","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.arth.2016.05.002","article-title":"Postoperative pain after primary total knee arthroplasty: comparison of local injection analgesic cocktails and the role of demographic and surgical factors","volume":"31","author":"Barrington","year":"2016","journal-title":"J Arthroplasty"},{"key":"2025101111224132000_45.11.847.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.9023"},{"key":"2025101111224132000_45.11.847.7","first-page":"629","article-title":"Persistent opioid use after arthroplasty","volume":"46","author":"Lennon","year":"2018","journal-title":"Anaesth Intensive Care"},{"key":"2025101111224132000_45.11.847.8","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.arth.2017.09.001","article-title":"Persistent opioid use following total knee arthroplasty: a signal for close surveillance","volume":"33","author":"Namba","year":"2018","journal-title":"J Arthroplasty"},{"key":"2025101111224132000_45.11.847.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2016.07.113"},{"key":"2025101111224132000_45.11.847.10","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.2106\/JBJS.16.01075","article-title":"Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among Opioid-Naive patients","volume":"99","author":"Schoenfeld","year":"2017","journal-title":"J Bone Joint Surg Am"},{"key":"2025101111224132000_45.11.847.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in US adults","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg"},{"key":"2025101111224132000_45.11.847.12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.drugalcdep.2018.02.013","article-title":"Long-term opioid use after inpatient surgery - A retrospective cohort study","volume":"187","author":"Bartels","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"2025101111224132000_45.11.847.13","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.arth.2016.09.040","article-title":"Chronic use of opioids before and after total knee arthroplasty: a retrospective cohort study","volume":"32","author":"Hansen","year":"2017","journal-title":"J Arthroplasty"},{"key":"2025101111224132000_45.11.847.14","doi-asserted-by":"crossref","first-page":"695","DOI":"10.2147\/JPR.S91924","article-title":"The Toronto General Hospital transitional pain service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain","volume":"8","author":"Katz","year":"2015","journal-title":"J Pain Res"},{"key":"2025101111224132000_45.11.847.15","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1111\/pme.12796","article-title":"Perioperative surgical home and the integral role of pain medicine","volume":"16","author":"Walters","year":"2015","journal-title":"Pain Med"},{"key":"2025101111224132000_45.11.847.16","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1213\/ANE.0000000000002280","article-title":"Role of the perioperative surgical home in optimizing the perioperative use of opioids","volume":"125","author":"Vetter","year":"2017","journal-title":"Anesth Analg"},{"key":"2025101111224132000_45.11.847.17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0073917"},{"key":"2025101111224132000_45.11.847.18","doi-asserted-by":"publisher","DOI":"10.1037\/\/1040-3590.7.4.524"},{"key":"2025101111224132000_45.11.847.19","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.12.6.458"},{"key":"2025101111224132000_45.11.847.20","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1016\/S0140-6736(19)30352-6","article-title":"Transition from acute to chronic pain after surgery","volume":"393","author":"Glare","year":"2019","journal-title":"Lancet"},{"key":"2025101111224132000_45.11.847.21","doi-asserted-by":"crossref","first-page":"e90","DOI":"10.1016\/j.bja.2019.02.015","article-title":"Time for accountability and change: institutional gaps in pain care during the opioid crisis","volume":"122","author":"Clarke","year":"2019","journal-title":"Br J Anaesth"},{"key":"2025101111224132000_45.11.847.22","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1007\/s11606-018-4463-1","article-title":"Transitions of care for postoperative opioid prescribing in previously Opioid-Na\u00efve patients in the USA: a retrospective review","volume":"33","author":"Klueh","year":"2018","journal-title":"J Gen Intern Med"},{"key":"2025101111224132000_45.11.847.23","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1213\/ANE.0000000000004569","article-title":"Mind over matter: reducing perioperative opioid use through patient education","volume":"130","author":"Dunn","year":"2020","journal-title":"Anesth Analg"},{"key":"2025101111224132000_45.11.847.24","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1213\/ANE.0000000000004319","article-title":"Preemptive and preventive pain Psychoeducation and its potential application as a multimodal perioperative pain control option: a systematic review","volume":"130","author":"Horn","year":"2020","journal-title":"Anesth Analg"},{"key":"2025101111224132000_45.11.847.25","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1213\/ANE.0000000000004436","article-title":"Educating patients regarding pain management and safe opioid use after surgery: a narrative review","volume":"130","author":"Lee","year":"2020","journal-title":"Anesth Analg"},{"key":"2025101111224132000_45.11.847.26","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.pmn.2008.07.003","article-title":"Postoperative pain management discharge teaching in a rural population","volume":"10","author":"Reynolds","year":"2009","journal-title":"Pain Manag Nurs"},{"key":"2025101111224132000_45.11.847.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2015.12.008"},{"key":"2025101111224132000_45.11.847.28","doi-asserted-by":"publisher","DOI":"10.1177\/000841740307000204"},{"key":"2025101111224132000_45.11.847.29","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jor.2020.01.020","article-title":"Effects of preoperative opioid education on postoperative opioid use and pain management in orthopaedics: a systematic review","volume":"20","author":"Rucinski","year":"2020","journal-title":"J Orthop"},{"key":"2025101111224132000_45.11.847.30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196404162701606"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2020-101797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:22:51Z","timestamp":1760206971000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2020-101797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,26]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,10,21]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/rapm-2020-101797"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2020-101797","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,26]]}}}