Optimizing Pain Management in a Postoperative Older Adult with a History of Chronic Pain and Opioid Dependence

Background: This case describes a multidisciplinary approach to optimizing pain management and reducing fall risk in an older adult patient with a history of chronic pain and suboptimal recovery after total knee arthroplasty. This patient experiences a decline in functional mobility that leads to an opioid-related ground-level fall. Assessment: Drug-drug interactions, the effects of prematurely discontinued physical therapy, and alternatives to a high-risk opioid regimen are assessed by clinicians from an outpatient team, including a transition-of-care pharmacist, physical therapist, and pain management pharmacist. Outcome: The team coordinates opportunities for reducing fall risk and improving pain management by decreasing drug interaction burden, leveraging nonpharmacological techniques, and improving the safety of the patient's opioid regimen via transition to a buprenorphine product. Conclusion: The case demonstrates the effect a multidisciplinary team can have on optimizing pain treatment and medication safety outcomes in older adults who have experienced an opioid-related event.