Optimal Management of Pain in Hospitalized Patients - Opioid Tolerant Populations.

Pain is a symptom that drives hospital admissions, and pain management is required by most patients during their hospital stay. Further, the use of medications such as opioids can lead to upward-spiraling doses, especially among chronic pain patients whose resource utilization rates are high. Many initiatives aim to reduce the costs of these "high-resource utilizing" patients. One exciting aspect of improving the management of pain is that this may help prevent patients from ever becoming high-cost in the first place. The purpose of this study is to examine the impacts of an early and sustained intervention pathway, in comparison to the current standard of care, for the treatment of pain in opioid tolerant patients. It is hypothesized that patients randomized to the intervention pathway, in comparison to the control, will lead to decreased costs of care, a reduction in opioid usage within 3 and 6 months, and decrease in hospital readmission rates.

patient readmission, pain relief units, pain centers, multidisciplinary pain clinics, multidisciplinary pain centers, pain clinics, hospital readmission, emergencies, emergency medicine, critical care, emergency treatment, opioid, acute pain service

Those randomized into the control group will receive the current standard of care for pain management. This standard care pathway involves a pain management specialist consultation only at the request of the primary admitting team. The pain management consultation can occur at any time during the patient's inpatient stay and care by these specialists ends at discharge.

Subjects randomized into the treatment (early intervention) group will receive the New Clinical Pathway: pain management care coordinated by pain-management specialists from inpatient admission through 60 days after discharge.

Opioid tolerance as inferred from opioid prescription and usage per FDA exposure threshold definition for opioid tolerance.

Measured upon day of discharge from index hospitalization; up to 18 months from the date of randomization

Measured upon day of discharge from index hospitalization; up to 18 months from the date of randomization

Inclusion Criteria: Adult patients (18 years and older) Known opioid tolerant (as determined per FDA criteria) Agree to sign the informed consent and HIPAA forms Exclusion Criteria: Patients under the age of 18 years No known opioid tolerance Do not agree to sign the informed consent and HIPAA forms

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