Preoperative Optimization of the Chronic Pain Patient

The literature increasingly supports the position that elective surgery on poorly prepared chronic pain patients is not smart and ultimately in no-one's best interest. Just as patients with ischemic heart disease, obstructive lung disease, or diabetes can and need to be optimized prior to surgery, so too should chronic pain patients. The complex dynamics of chronic pain require a priori intervention - targeting enhanced recovery before surgery.

Preoperative Optimization of the Chronic Pain Patient is a groundbreaking collaborative effort written by medical and psychological experts in the field of pain management with a specific interest in the perioperative arena. The modern emphasis on biopsychosocial-spiritual care is as important here as anywhere in medicine as comprehensive mind-body preparation is essential to optimize outcomes. That preparation entails replacing toxic thoughts (e.g., anxiety and pain catastrophizing) and behaviors (e.g., tobacco and opioid dependence; poor sleep, nutrition and exercise patterns) with beneficial ones. Such replacement of maladaptive cognitive-behavioral patterns requires the enhancement of patients' motivation and the cultivation of healthy habits.

This book provides the framework for an evidence-based synthesis of counseling and intervention for preoperative optimization of chronic pain patients. Clinicians will learn to improve health and economic outcomes affecting their patient, health care team, and institution; to identify and target relevant issues, utilizing a holistic yet focused approach to optimization; and to collaborate with the patient and requisite multidisciplinary care team in a streamlined, efficient, and effective manner.

Table of Contents

1. Scope of the Problem: Complications and Costs of Perioperative Chronic Pain
2. Rationale and Process Overview for Preoperative Optimization of Chronic Pain
3. The Primacy of Motivation in Preoperative Optimization
4. The Pragmatism of Habit in Preoperative Optimization
5. Pain Catastrophizing and Anxiety
6. Sleep Optimization
7. Preoperative Physical Conditioning
8. Preoperative Nutritional Management
9. Preoperative Management of Tobacco
10. Preoperative Management of Chronic Opioid Therapy
11. Putting It All Together