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

Abstract

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.

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Keywords:

• transitional pain service
• postsurgical pain
• chronic pain
• opioid dependence
• opioid weaning
• acceptance and commitment therapy

Acknowledgments

Funding for the Transitional Pain Service provided by the Ontario Ministry of Health and Long-Term Care. JK is supported by a Canadian Institutes of Health Research Canada Research Chair in Health Psychology at York University. HC is supported by a Merit Award from the Department of Anesthesia, University of Toronto.

Disclosure

The authors report no conflicts of interest in this work.