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Tao X, Luo G, Xiao J, Yao Y, Gao Q, Zou J, Wang T, Cheng Z, Sun D, Yan M. Chronic Postsurgical Pain Following Lung Transplantation: Characteristics, Risk Factors, Treatment, and Prevention: A Narrative Review. Pain Ther 2024; 13:719-731. [PMID: 38809395 PMCID: PMC11254876 DOI: 10.1007/s40122-024-00615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
Chronic pain after lung transplantation (LTx) can substantially reduce quality of life (QoL), yet current consensus guidelines say little about how to prevent or manage it. Research on pain after LTx has tended to focus on acute rather than chronic pain, and it has not extensively examined the factors associated with onset or resolution of chronic pain, which differ from factors influencing chronic pain after general thoracic surgery. This narrative review explores what is known about the epidemiology and risk factors of chronic pain after LTx, as well as effective ways to treat or prevent it. The review identifies key questions and issues that should be the focus of future research.
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Affiliation(s)
- Xinchen Tao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Ge Luo
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Jie Xiao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuanyuan Yao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Qi Gao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Jingcheng Zou
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Tingting Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Dawei Sun
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China.
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Yu HC, Kleiman V, Kojic K, Slepian PM, Cortes H, McRae K, Katznelson R, Huang A, Tamir D, Fiorellino J, Ganty P, Cote N, Kahn M, Mucsi I, Selzner N, Rozenberg D, Chaparro C, Rao V, Cypel M, Ghanekar A, Kona S, McCluskey S, Ladak S, Santa Mina D, Karkouti K, Katz J, Clarke H. Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service. Transplantation 2023; 107:1398-1405. [PMID: 36482750 DOI: 10.1097/tp.0000000000004441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants. METHODS In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen. RESULTS Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption. CONCLUSIONS Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.
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Affiliation(s)
- Hai Chuan Yu
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Valery Kleiman
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Katarina Kojic
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada
| | - P Maxwell Slepian
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Henry Cortes
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Alex Huang
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Tamir
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Fiorellino
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Praveen Ganty
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Nathalie Cote
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Michael Kahn
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Nazia Selzner
- Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine, Division of Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cecilia Chaparro
- Division of Respirology, Department of Medicine, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Vivek Rao
- Peter Munk Cardiac Centre of the University Health Network, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Department of Cardiovascular Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Anand Ghanekar
- Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sharath Kona
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Stuart McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Salima Ladak
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
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Lewis TC, Sureau K, Katz A, Fargnoli A, Lesko M, Rudym D, Angel LF, Chang SH, Kon ZN. Multimodal opioid-sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block. Clin Transplant 2021; 36:e14512. [PMID: 34658078 DOI: 10.1111/ctr.14512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
Opioid analgesics are commonly used post-lung transplant, but have many side effects and are associated with worse outcomes. We conducted a retrospective review of all lung transplant recipients who were treated with a multimodal opioid-sparing pain protocol. The use of liposomal bupivacaine intercostal nerve block was variable due to hospital restrictions. The primary objective was to describe opioid requirements and patient-reported pain scores early post-lung transplant and to assess the impact of intraoperative liposomal bupivacaine intercostal nerve block. We treated 64 lung transplant recipients with our protocol. Opioid utilization decreased to a mean of 43 milligram oral morphine equivalents by postoperative day 4. Median pain scores peaked at 4 on postoperative day 1 and decreased thereafter. Only three patients were discharged home with opioids, all of whom were taking opioid agonist therapy pre-transplant for opioid use disorder. Patients who received liposomal bupivacaine intercostal nerve block in the operating room had a significant reduction in opioid consumption over postoperative day 1 through 4 (228 mg vs. 517 mg, P= .032). A multimodal opioid-sparing pain management protocol is feasible and resulted in weaning of opioids prior to hospital discharge.
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Affiliation(s)
- Tyler C Lewis
- Department of Pharmacy, NYU Langone Health, New York, New York, USA.,Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Kimberly Sureau
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Alyson Katz
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | - Anthony Fargnoli
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Melissa Lesko
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Darya Rudym
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Luis F Angel
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, Northwell Health, Manhasset, New York, USA
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Laurent Q, Michel-Cherqui M, Szekely B, Glorion M, Sage E, Trichereau J, Fischler M, Fessler J, Guen ML. Prevalence, Characteristics and Preoperative Predictors of Chronic Pain After Double-Lung Transplantation: A Prospective Cohort Study. J Cardiothorac Vasc Anesth 2021; 36:500-509. [PMID: 34479783 DOI: 10.1053/j.jvca.2021.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Data on chronic pain after lung transplantation are heterogeneous. This study prospectively explored the prevalence, characteristics, consequences, and preoperative predictors of pain in lung transplant recipients. DESIGN A prospective cohort study. SETTING The Foch University Hospital, Suresnes, France. PARTICIPANTS Patients registered on the waiting list for double-lung transplantation in the authors' institution from August 2008 to October 2013 and transplanted. INTERVENTIONS Database prospectively completed in real time during consultations with a pain-certified anesthesiologist before lung transplantation and six months after surgery. MEASUREMENTS AND MAIN RESULTS The assessments explored pain in three components: physical (intensity, location, neuropathic and sensory qualifications, treatments), mental (anxiety and depression), and quality of life. Seventy-two patients underwent all assessments. The prevalence of six-month postoperative pain was 68.0%. Among patients with pain, 83.3% reported mild average pain and 26.5% had neuropathic pain. All patients who responded to the questionnaire took analgesics frequently, but only 9.1% took opioids. Patients with pain reported higher levels of anxiety (p = 0.02) and depression (p = 0.01). Additionally, they presented with increased difficulty in ambulation (p = 0.03), work (p = 0.02), and sleep (p = 0.02). The maximum level of preoperative pain was an independent risk factor of six-month postoperative pain (p = 0.03). CONCLUSIONS The authors report a high prevalence of chronic pain with concomitant psychosocial repercussions despite a reported mild intensity. Perioperative measures, such as personalized and detailed management plans, could improve patient satisfaction.
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Affiliation(s)
- Quentin Laurent
- Department of Anesthesiology and Pain Management Clinic, Hôpital Foch, 92150 Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Mireille Michel-Cherqui
- Department of Anesthesiology and Pain Management Clinic, Hôpital Foch, 92150 Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Barbara Szekely
- Department of Anesthesiology and Pain Management Clinic, Hôpital Foch, 92150 Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Matthieu Glorion
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Julie Trichereau
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Marc Fischler
- Department of Anesthesiology and Pain Management Clinic, Hôpital Foch, 92150 Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
| | - Julien Fessler
- Department of Anesthesiology and Pain Management Clinic, Hôpital Foch, 92150 Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Management Clinic, Hôpital Foch, 92150 Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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