Evaluating a Transitional Pain Service Program for Opioid Discontinuation: A Retrospective Cohort Study
Bibliographic record
Abstract
Background: The Transitional Pain Service (TPS) was established by the University Health Network in Toronto in 2014 to support patients with chronic post-surgical pain and pain-related disabilities. We evaluated whether treatment through the TPS is associated with different opioid discontinuation outcomes, compared to patients in a Comparator Group. Methods: We performed a time-to-event analysis of patients enrolled in the TPS between March 1st, 2014 to December 31st, 2018. Using linked ICES administrative data and TPS clinical data, patients were observed for 1-year following hospital discharge. We measured time to opioid discontinuation, defined as 45-days without filling an opioid prescription, for the Treatment Group (2 or more clinic visits) compared to a Comparator Group (1 clinic visit). A Propensity Score Matching (PSM) was conducted in the secondary analysis to examine opioid discontinuation outcomes by comparing Ontario patients with similar surgery types to those performed on TPS patients. A supplementary analysis was conducted by dividing the TPS data into tertiles (group 1= 1 clinic visit; group 2= 2 to 4 clinic visits; group 3= ≥ 5 visits) in the interests of further interpreting the results from the primary and secondary analyses. Results: The study included 416 TPS patients, with 127 in the Comparator Group, and 289 in the Treatment Group. A greater proportion of patients in the Comparator Group were significantly more likely to discontinue opioids within 1-year post-surgery compared to the Treatment Group (89% versus 76%; p-value: <0.001). In the secondary analysis, results were consistent when comparing the PSM Comparator Group and the Treatment Group. The supplementary analysis revealed significantly higher scores in TPS groups 2 and 3 compared to TPS group 1, for Pain Interference, Pain Catastrophizing, Hospital Anxiety and Depression, and Sensitivity and Pain Traumatization Scales, whereas no significant differences were found between TPS group 2 and TPS group 3. Conclusion: The findings revealed that patients who require extended TPS clinic visits face higher health complexities in pain and mental health, thus highlighting the need for on-going continuity of care. Future research using randomized controlled trials are recommended to understand the treatment effects of the TPS.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".