Preoperative Optimization of the Chronic Pain Patient: Enhanced Recovery Before Surgery

by Heath B. McAnally, Lynda Welton Freeman, Beth Darnall

Overview

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.

Product Details

ISBN-13:	9780190920142
Publisher:	Oxford University Press
Publication date:	09/23/2019
Pages:	286
Product dimensions:	9.30(w) x 6.20(h) x 1.10(d)

About the Author

Heath B. McAnally, MD, MSPH, Medical Director, Northern Anesthesia and Pain Medicine, Eagle River, Alaska and Clinical Instructor, Department of Anesthesiology and Pain Medicine, University of Washington. Lyn Freeman, PhD, Owner, Mind Matters Research and Director of Integrative Medicine, Alaska Regional Hospital, Anchorage, Alaska. Beth Darnall, PhD, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine

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

Editorial Reviews

Reviewer: Robert R. Gaiser, MD (Yale School of Medicine)
Description: This is a comprehensive review of the preoperative optimization of the chronic pain patient. The authors chose this patient population due to the difficulty in management and the poor understanding on the part of the medical community of those with chronic pain. The book covers all areas that should be optimized preoperatively, with useful suggestions. The approach is evidence-based and clearly would improve the care of this patient population in the perioperative period.
Purpose: The purpose is to help providers in the preoperative optimization of patients with chronic pain. The authors address all areas that may result in poor outcome if not addressed in the preoperative area. The goal is laudable and achievable with the suggestions.
Audience: It is unclear who the intended audience is. The book appears to be directed at practicing anesthesiologists, yet it is written at a level appropriate for patients with chronic pain. It also may be more appropriate for psychologists, although psychologists are not typically involved in the preoperative optimization of the patient presenting for surgery.
Features: Although the book addresses areas of optimization prior to surgery for patients with chronic pain, these areas apply to all patients. All patients should have nutritional status, smoking, and physical fitness improved prior to surgery. The benefit is not greater if the patient has chronic pain. The section on preoperative opioid management is the only one applicable to these patients. A chapter on habits is interesting from a nonmedical perspective but practicing anesthesiologists would not find it interesting while practicing psychologists would find it too basic. It may be written for patients with chronic pain. The figures are clear with minimal accompanying text as they are self-explanatory.
Assessment: This book addresses an area that is not addressed in any other books. However, it is unclear if such a book is required, as most of this information applies to any patient presenting for surgery. The chapters are too wordy for anesthesiologists and possibly too basic for psychologists. References are comprehensive. There are no other books like this, but this lack is most likely because it is not needed.

Doody's Review Service

"I would recommend this book to all anesthesiologists (and surgeons), and it should become essential reading for all trainees in anesthesia, surgery, and pain medicine." — C. Roger Goucke, International Anesthesia Research Society

"[This] is a valuable book for clinicians running Pain Management Programmes (PMP). It will be a good resource for someone looking for evidence based foundations to build a new transitional pain clinic and PMP." — Romana Shaida Durrani, Anaesthesia, Pain & Intensive Care

"This is a volume that could and should become part of the reading list for trainee anesthesiologists and anesthetists ... [it] is a valuable book for addressing a critical component of preoperative management of the patient with chronic pain ... [and] complements standard anesthesiology texts on the preoperative preparation of surgical patients." — Peter R. Wilson, American Academy of Pain Medicine

From the Publisher