title: 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.
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Psychology, York University.
authors.forename: Aliza Z
authors.initials: AZ
authors.lastname: Weinrib
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Psychology, York University.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Burns
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network.
authors.forename: Alex
authors.initials: A
authors.lastname: Mu
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Psychology, York University.
authors.forename: Muhammad Abid
authors.initials: MA
authors.lastname: Azam
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network.
authors.forename: Salima Sj
authors.initials: SS
authors.lastname: Ladak
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: McRae
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rita
authors.initials: R
authors.lastname: Katznelson
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network.
authors.forename: Saam
authors.initials: S
authors.lastname: Azargive
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network.
authors.forename: Cieran
authors.initials: C
authors.lastname: Tran
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Psychology, York University; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
authors.affiliation: Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hance
authors.initials: H
authors.lastname: Clarke
keywords: acceptance and commitment therapy; chronic pain; opioid dependence; opioid weaning; postsurgical pain; transitional pain service