Pain management pilot seeks to enhance pain support for patients after surgery

In 2008, clinical pharmacist, Dr. Emily Johnston, was a new graduate from Dalhousie University heading into her first role with a community pharmacy in Calgary at the height of the opioid crisis. During this time, she would see use of prescribed and non-prescribed opioids that would shape and inform her scope of research going forward.

“As my own clinical practice evolved, I ended up working in orthopedics and managing post-surgery pain using those same medications. It became a full-circle moment for me,” said Dr. Johnston. “I was asking similar questions to what I was thinking back then – ‘are we treating these patients’ pain as best as we can?’”.

This question was the catalyst to Dr. Johnston’s research into how surgery patients can best be supported while taking prescribed opioids as part of their recovery. She began exploring what opioids were being prescribed for scheduled hip and knee joint replacement patients and reviewed risk and patient-specific factors for prolonged opioid use after these surgeries.

Working alongside Dr. Michael Dunbar, orthopedic surgeon and QEII Foundation Endowed Chair of Arthroplasty Outcomes and orthopedic surgeons, Dr. Glen Richardson, Dr. Jennifer Leighton and Dr. Duncan Smith, Dr. Johnston launched a pain management pilot to help patients manage their pain after their surgery.

The pilot involved patients interacting with forms and a text message service that allowed them to assess their pain regularly, and use this information to make choices about how they manage it.

The pilot also promoted the use of non-medication therapies like music therapy, breathing exercises and guided imagery, which are evidence-based ways to manage pain that have been studied in joint replacement patients. 

Ideally, patients will be able to educate themselves about post-operative pain management so they can better manage their pain after surgery. They will also be able to advocate for their own health, making their preferences known to their surgeon and care team to prevent prolonged use, reduce emergency room visits related to poor pain control, and get the best results from their surgery. These are important improvements for patients and can also reduce demands on the health care system, allowing more patients to get the support and surgeries they need sooner.

“Conversations with the research team, and specifically Dr. Dunbar, led me to pitching an idea to the Nova Scotia Health’s Innovation Hub and consequently receiving the Innovation Catalyst Grant which helped me leverage a lot of support around developing this idea,” said Dr. Johnston.

Dr. Johnston has also received support through Volta, Canada’s East Coast Innovation Hub, federal programs and grants from Invest Nova Scotia to help continue the development of this program to an app for patient use.

The feasibility study was completed in May 2023 with 49 patients. The feedback Dr. Johnston received has been critical and is now shaping the development of an app for patient use that will be part of further clinical trials.

“The vision or the goal is to provide enough supports to patients and surgeons that we can study how patients are using their opioids at home after surgery with the hopeful end result to minimize the length of time opioids are used and that patients are prescribed fewer opioids over time.” 

Visit www.paincoachapp.com to learn more about Pain Coach Inc as they move forward.

About Opioids

Opioids are drugs that are usually prescribed to treat acute pain and pain that comes at the end of life. They’re psychoactive drugs, meaning they act in our brains to change our awareness of pain, as well as slow down our breathing, heart rate, thoughts, and actions. There are many different opioids, including morphine, heroin, hydromorphone (Dilaudid) and codeine (in products like Tylenol 1). Opioid use for as little as 10 days leads to dependence and can lead to the development of a substance use disorder. Dependence means the body has become used to having the drug circulating and reacts to it being taken away or reduced. A substance use disorder is a form of addiction that involve compulsive use, craving, loss of control and continued use despite negative consequences. 

Learn more about opioids and supports available to help with dependence at:

https://mha.nshealth.ca/en/topics

Prescription Opioids (Canadian Drug Summary) (ccsa.ca)

If you are an NSH physician, nurse practitioner or pharmacist, and need advice on how to identify or manage care for a patient with opioid use disorder (OUD), advice is available Monday to Friday 8:30 a.m. – 4:30 p.m. by calling the Addiction Medicine Consult Service at 855-970-0234.