Chronic opioid users undergoing surgery are at increased risk of CPSP, contributing to long-term disability, decreased quality of life, and prolonged opioid exposure. Existing preventive strategies remain limited, and early postoperative monitoring may represent a key opportunity for intervention. Evidence suggests that transitional pain services can improve outcomes by optimizing pain control and reducing long-term opioid consumption, but implementation is heterogeneous and often resource-intensive. Telemedicine offers a scalable alternative, enabling early specialized evaluation and timely therapeutic adjustments while maintaining accessibility. This randomized controlled trial will compare standard postoperative follow-up with standard follow-up plus a specialized teleconsultation performed between postoperative day 15 and 28. The intervention aims to detect insufficiently controlled pain, signs of neuropathic pain, or maladaptive opioid use, and to propose individualized therapeutic adjustments when required.
Participants will be followed for 6 months. Primary assessment will occur at 3 months to determine CPSP incidence. Secondary assessments will include pain trajectory (intensity, neuropathic features, functional interference), opioid consumption and misuse, quality of life, and a descriptive medico- economic evaluation
Age ≥18 years
Elective non-urgent surgery with expected moderate or higher postoperative pain
Chronic preoperative opioid use
Written informed consent
Ambulatory surgery
Endoscopic or palliative surgery
Patients receiving opioid substitution therapy
Non-medical opioid use
Parallel
standard institutional perioperative management
Other interventionstandard institutional perioperative management
specialized teleconsultation
Other interventionPatients in the intervention arm participate in a specialized teleconsultation between postoperative day 15-28 to detect poorly controlled pain, neuropathic features, or opioid-related concerns, and to adjust treatment if needed.
Incidence of chronic postsurgical pain (CPSP)
Incidence of chronic postsurgical pain (CPSP) at 3 months, defined as: * new or aggravated postsurgical pain located at the surgical site or innervated territory, * persistent for ≥3 months, * intensity ≥3/10 (new pain) or increase ≥2/10 from baseline (aggravation), * with significant functional impact (≥3/10 on at least one Brief Pain Inventory interference item), * assessed at day 90 ±14.
Pain trajectory
Pain trajectory is measured by using intensity (BPI), + neuropathic features (DN4) +Quality of life (EQ-5D-5L)
Pain trajectory
Pain trajectory is measured with intensity (BPI), neuropathic features (DN4), Quality of life (EQ-5D- 5L)
Opioid use
Opioid use is defined as oral morphine equivalent consumption, proportion with reduction/discontinuation, POMI-5F, SOWS, DSM-5 OUD criteria
Opioid use
Opioid use is defined as oral morphine equivalent consumption, proportion with reduction/discontinuation, POMI-5F, SOWS, DSM-5 OUD criteria
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