VA Transitional Pain Service Study

NCT06223503 | Recruiting DMC

• 1 other identifier: IIR 22-062
• Study Type: interventional
• Target: 400
• Locations: 1 country
• Sites: 1

Brief Summary

The VA Community Care Program has provided an important resource to improve access to surgical care for Veterans unable to have treatment at VA Medical Centers (VAMC). However, there is an increased risk of developing chronic opioid use when at-risk surgical patients receive opioids from non-VA providers. A multidisciplinary approach to perioperative pain management known as the Transitional Pain Service (TPS) has been shown to effectively reduce chronic opioid use among Veterans after surgery, but it is unknown whether it can be used to achieve the same outcomes for Veterans using Community Care for high-risk surgery. Through this project, the investigators will generate important data to establish whether a telehealth TPS approach can serve as a scalable and effective strategy to ensure safe opioid use among Veterans undergoing orthopedic surgery. The investigators will randomize Veterans using Community Care for orthopedic surgery to telehealth TPS versus standard of care. Finally, the investigators will interview patients using Community Care to better understand barriers and facilitators to telehealth TPS and Veteran satisfaction with the approach to pain management.

Conditions

Chronic Opioid Use

Keywords

Post-operative pain; Opioid use disorder; Opioid misuse; MISSION Act; Community Care; Transitional Care Coordination

Outcome Measures

Primary Outcomes (1)

• Persistent post-surgical opioid use

  The percentage of non-chronic opioid use Veterans who continue post-surgical use past 90 days after surgery.

  90 days after surgery

Secondary Outcomes (7)

• Quantity of opioids prescribed (MME/day)

  90 days after surgery

• PROMIS Assessment of Pain Intensity and Pain Interference

  7, 30, 60, and 90-days after surgery

• Assessment of Care Coordination

  7 days after surgery

• Visit with Primary Care Provider within 30 days after surgery.

  30 days after surgery

• Number of opioid refills after discharge from surgery

  Between discharge from surgery and 90-days after surgery

Study Arms (2)

Telehealth Transitional Pain Service + Standard Postoperative Follow-Up Care

EXPERIMENTAL

Telehealth Transitional Pain Service + Standard Postoperative Follow-Up Care

Behavioral: Transitional Pain Service

Standard Follow Up Care

ACTIVE COMPARATOR

Standard Follow Up Care

Behavioral: Transitional Pain Service

Interventions

Transitional Pain Service BEHAVIORAL

The Transitional Pain Service (TPS) is a novel perioperative surgical home approach that consists of comprehensive pain management and care coordination before, during and for at least 6-months after surgery for Veterans at risk for chronic opioid use (COU).

Standard Follow Up Care; Telehealth Transitional Pain Service + Standard Postoperative Follow-Up Care

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aims 1 \& 3:
• The investigators will include Veterans who are referred to the Veteran Community Care Program (VCCP) for an orthopedic surgery procedure from any VA medical center throughout VISN-19.
• Additionally, these Veterans must be 18+ years of age who are not on chronic opioids at the time of surgery, and who have a VA primary care provider (PCP).
• Aim 2:
• Veterans who received TPS (Aim 1) and referring VA Primary Care Providers.

You may not qualify if:

• Aim 1:
• The investigators will exclude Veterans who are scheduled for other types of surgical procedures, are on chronic opioid therapy before surgery, are on hospice or end-of-life care, are cognitively impaired, or unable to complete the follow-up visits for any other reason.
• Aim 2:
• The investigators will exclude Veterans not randomized to the TPS Telehealth intervention of Aim 1.
• Primary Care Providers will be excluded if they do not primarily work at the VA.
• Aim 3:
• The investigators will exclude Veterans who were not randomized to the TPS Telehealth intervention.
• Veterans who experienced a major complication during the perioperative period or experienced an extended length of stay (LOS) based on exceeding the upper interquartile range of median LOS.

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

VA Salt Lake City Health Care System, Salt Lake City, UT

Salt Lake City, Utah, 84148-0001, United States

RECRUITING

Related Publications (4)

• Yoo M, Buys MJ, Nelson RE, Patel S, Bayless KM, Anderson Z, Hales JB, Brooke BS. Effect of Multidisciplinary Transitional Pain Service on Health Care Use and Costs Following Orthopedic Surgery. Fed Pract. 2023 Dec;40(12):418-425. doi: 10.12788/fp.0438. Epub 2023 Dec 12.

  PMID: 38812900 BACKGROUND

• Buys MJ, Anderson Z, Bayless K, Zhang C, Presson AP, Hales J, Brooke BS. Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study. Reg Anesth Pain Med. 2025 Jul 4;50(7):531-537. doi: 10.1136/rapm-2023-105162.

  PMID: 38677883 BACKGROUND

• Arnaoutakis DJ, Nguyen T, Zheng X, Mao J, Patel S, Matar AH, Brooke BS, Bismuth J, Stone DH, Scali ST. Large endograft diameter is associated with poor outcomes following thoracic endovascular aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg. 2025 Dec;82(6):1947-1956.e3. doi: 10.1016/j.jvs.2025.06.030. Epub 2025 Jun 26.

  PMID: 40581193 BACKGROUND

• Brooke BS, Bayless K, Anderson Z, Holeman TA, Zhang C, Hales J, Buys MJ. Opioid tapering after surgery and its association with patient-reported outcomes and behavioral changes: a mixed-methods analysis. Reg Anesth Pain Med. 2024 Oct 8;49(10):699-707. doi: 10.1136/rapm-2023-104807.

  PMID: 37865394 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative; Opioid-Related Disorders

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Narcotic-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders

Study Officials

• Benjamin S Brooke, MD PhD

  VA Salt Lake City Health Care System, Salt Lake City, UT

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Benjamin S Brooke, MD PhD

CONTACT

(801) 582-1565; Benjamin.Brooke@hsc.utah.edu

Julie L Hales

CONTACT

(801) 582-1565; julie.hales@va.gov

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: Veterans will be randomized to either be enrolled into the Salt Lake City VAMC transitional pain service or to receive only the usual care through the community care surgeon.

Study Record Dates

• First Submitted: January 11, 2024
• First Posted: January 25, 2024
• Study Start: March 1, 2024
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): July 1, 2027
• Last Updated: May 6, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)