RESUMEN
INTRODUCTION: Chronic pain is a common complication after surgery and trauma. The incidence of chronic pain may potentially be reduced by effective management of severe acute pain, in hospital and during the subacute post-operative phase at home. METHODS: This was a cohort study from an outpatient follow-up service for patients with pain at discharge after orthopaedic surgery and trauma in a level 1 university hospital setting. The patients' charts were reviewed. Demographics, diagnosis and treatment were registered. The objective of this study was to describe the first five years of experience with this service. RESULTS: A total of 261 patients were included. The median age was 39 (interquartile range (IQR): 26-76) years, and 53% were men. The median pain duration was ten (IQR: 5-22) months. Neuropathic pain was diagnosed in 83% of patients. Complex regional pain syndrome was diagnosed in 10% and suspected in 8%. Before the consultation, 48% were using paracetamol and/or non-steroid anti-inflammatory drugs (NSAIDs), 25% opioids, and 36% used gabapentioids or antidepressants. After their consultation, only 13% used paracetamol and/or NSAIDs and 8% opioids, whereas 86% were treated with gabapentinoids or antidepressants. A plan for opioid weaning was provided for all patients if opioids were continued (8%). CONCLUSIONS: Establishing an outpatient pain service for persistent pain after surgery and trauma may encourage the use of analgesia regimens that are in accordance with international guidelines and ensure that opioids are not continued inappropriately. FUNDING: None. TRIAL REGISTRATION: Not relevant.
Asunto(s)
Dolor Crónico , Procedimientos Ortopédicos , Masculino , Humanos , Adulto , Femenino , Acetaminofén/uso terapéutico , Pacientes Ambulatorios , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/etiología , Estudios de Cohortes , Antiinflamatorios no Esteroideos/uso terapéutico , Procedimientos Ortopédicos/efectos adversos , Analgésicos Opioides/uso terapéutico , Antidepresivos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiologíaRESUMEN
In recent years, the use of opioids in Denmark has been under scrutiny due to various government measures to reduce consumption, greater media focus and Denmark's relatively larger consumption of opioids compared with the Nordic neighbours. Consequently, opioid prescriptions in Denmark have declined since 2017. A more nuanced approach to opioid treatment for non-malignant chronic pain, which includes individualised treatment as well as enhanced interdisciplinary collaboration, is required as argued in this review.