Prospective Randomized Study of TPS + CBT VS TPS Alone: Readmission, Opioid Use, and Chronic Pain

Prospective Randomized Study Of Transitional Pain Service (TPS) With Mini-Cognitive Behavioral Therapy (CBT) Versus TPS Alone For Evaluating Hospital Readmission, Opioid Outcomes, And Chronic Post-Surgical Pain

This study aims to evaluate the impact of a Transitional Pain Service (TPS) on hospital readmission rates, opioid consumption, and chronic post-surgical pain(CPSP), Despite increasing recognition of the benefits of integrated transitional pain care, there are limited prospective data evaluating its impact on 30-day readmissions, longitudinal opioid use, and CPSP. This protocol will systematically collect prospective patient data to assess these outcomes.

Primary Objective:

To compare the 30-day hospital readmission rate in patients seen by to the Transitional Pain Service.

Secondary Objectives:

1. To evaluate reduction in opioid use (MME) at 30, 60, 90, 180, and 365 days.

2. To evaluate patient reported outcomes using BPI, CAGE-AID, SOAPP-14, ESAS, PROMIS-29 at 30, 60, 90, 180, and 365 days to assess patient-reported quality of life and pain outcomes longitudinally.

3. To evaluate the incidence of CPSP

4. To assess demographic and clinical predictors of readmission and opioid reduction.

5. Compare outcomes between TPS patients who receive a brief, skills-based mini-CBT group intervention vs. TPS patients who do not receive mini-CBT, including:

   • Time trends across 30, 60, 90 days, and 6 and 12 months.
   • Opioid use (daily MME), and proportion achieving ≥30% MME reduction from baseline;
   • Pain intensity (NRS/10), BPI severity & interference, PROMIS-29 domains;
   • beyond 30-day hospital readmission rate

Inclusion Criteria:

Chronic pain syndrome Patients with a h/o or current substance use Patients on a daily opioid dose (morphine equivalency) of ≥90 Consulted for transitional pain service

Exclusion Criteria:

Not seen by transitional pain service