Preoperative Optimization Of The Chronic Pain Patient

"Elective surgery on poorly prepared patients suffering with chronic pain and comorbid substance dependence is increasingly shown to confer suboptimal outcomes - both clinical and economic. Achieving biopsychosocial 'fitness for surgery' for these patients often requires a process similar to preoperative optimization of cardiac and other chronic diseases, with modification / elimination of risk factors (in many cases shared with those diseases.) These risk factors are not so much genetic or uncontrollable, but rather behavioral, and comprise toxic thoughts and toxic habits. The preoperative optimization program for chronic pain patients, presented in this book focuses on high-yield modifiable targets that are supported by the literature and the authors' clinical experience. These comprise tobacco cessation, preoperative opioid reduction or elimination, slow-wave sleep enhancement, nutritional and exercise "prehabilitation", and reduction of anxiety and pain catastrophization Preoperative Optimization, Chronic pain, Risk Factors, Enhanced Recovery, Ambulatory Surgery, Elective Surgery, Biopsychosocial, Motivation, Habit, Motivational Interviewing, Motivational Enhancement, Prehabilitation"--

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.

Primum non nocere... The fact that a surgical procedure can leave any kind of pain casts a shadow over this tenet, which is seen as the basis of medical practice and anchor of its principle ethic... It is all the more surprising in that medicine has only paid attention to this paradoxical chronic pain situation for the past few years. Clarifying the knowledge acquired in this field has become all the more urgent for any care-giver today confronted by a legitimate request from patients: Why and how can a surgical procedure, which is supposed to bring relief, leave behind an unacceptable sequela? This is the approach which the contributors to this new subject of major clinical interest invite you to follow as you work your way through this book.

Acute Pain Medicine is the first comprehensive, case-based text of its kind that explores the essential topics of acute pain medicine, including interventional, pharmacologic, and diagnostic considerations. Written and edited under the auspices of the American Academy of Pain Medicine by members of the Academy's Shared Interest Group for Acute Pain Medicine, the text includes an introduction to acute pain medicine and an easily referenced interventional section. Chapters focus on patients experiencing acute pain from either surgery or other medical conditions and include detailed information on the diagnosis and treatment of specific cases in acute pain medicine. The text is rounded out by the complete content of the thoroughly revised Military Advanced Regional Anesthesia and Analgesia Handbook (MARAA II). Although the MARAA handbook gained its reputation as a useful resource for managing the pain associated with battlefield trauma, its beautifully illustrated step-by-step guidance is useful for providing vital acute pain services in all settings. Acute Pain Medicine is an ideal, complete resource for physicians, fellows, and residents managing acute pain patients.

Up to 35% of adults suffer from chronic pain, and a substantial number of these patients are admitted to hospitals every year. A major concern of these patients is whether the pain will be adequately controlled during hospitalization. these patients are more likely to have poor pain control and may experience an exacerbation of their co-exisitng chronic pain condition during hospital admission. Adequate pain control is directly related to clinical outcomes, length of hospital stay, and patient satisfaction. A considerable body of evidence demonstrates the medical, social, and economic benefits of satisfactory inpatient pain control. Currently, there are limited pain control guidelines to address this challenging inpatient population. In fact, there are no guidelines outlinign best practices for postoperative pain control in patients with chronic pain. The complex nature of chronic pain and a dearth of publications addressing the concerns of these patients make the creation of relevant guidelines difficult. The goal of this book is to equip clinicians to provide safe and effective management of hospitalized patients with co-existing chronic pain. Each chapter addresses a particular clinical question and is written by an expert in the field. Chapters describe basic principles and specific clinical situations commonly encountered during the care of patients with co-existing chronic pain in hospital settings.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Concise, practical, and packed full of clinical information, the Oxford Handbook of Surgical Nursing is the essential resource for all those working in nursing practice surgery and its sub-specialties. Easily-accessible, this handbook provides all of the information and practical advice needed to care effectively and professionally for surgical patients. This handbook provides a thorough introduction to the principles and practice of the care of patients undergoing the range of surgical procedures. It covers all of the core elements of surgical care from point of diagnosis, through to discharge and rehabilitation. The Oxford Handbook of Surgical Nursing provides clinical knowledge and skills for managing complex cases in the hospital or clinic. This guide will assist the reader in understanding the core role of the surgical nurse within the modern surgical team, to plan, implement and evaluate patient care delivery, and to manage complications arising from surgery. Evidence-based, and following the latest national guidelines, you can be sure this will be an indispensable companion, for all nurses, whether new to the specialty, or more experienced in surgical care.

This book uses a case-based approach to provide current information on a range of medical issues with the goal of enhancing preoperative evaluation and optimization. It meets the market need for a resource that concisely encapsulates current knowledge on the medical management of specific topics in a setting relevant to the preoperative clinic. In so doing the book aims to improve patient care and safety, enhance resource use, facilitate appropriate and timely management of preexisting conditions and diminish patient concerns. Organized into sections according to body system, each section consists of chapters delineating a specific disorder. Each chapter starts with a clinical vignette followed by a question-and-answer style investigation of the relevant issues. These questions attempt to address commonly encountered clinical dilemmas where opinion often differs between, and occasionally within, medical sub-specialties. Expertly written chapters are also supplemented by a number of chapters which address special considerations such as the frail patient and chronic opioid use. Preoperative Assessment: A Case-Based Approach is an invaluable reference for all physicians involved in preoperative assessment including anesthesiologists, surgeons, internists, family doctors and residents in these fields. Nurse practitioners and other allied heath professionals involved in preoperative evaluation may also find this a book a valuable and timely resource.