Pain is an unfortunate daily experience for many individuals.
Chronic pain -- lasting six or more months -- is suffered by
approximately 30% of the population in the United States. These
individuals wake up, function during the day and go to sleep,
trying to keep pain at a minimum while, at the same time,
maintaining some quality of life. They may make frequent visits to
the doctor and the pharmacy. When they find relief, it is usually
short-lived and comes at a cost such as dependence on narcotic
medications or complete limitation of activity. Pain often becomes
the central point of their existence. This practice guide describes
an approach to psychological evaluation of the chronic pain patient
who is being considered for surgery. A large body of research is
accumulating which demonstrates that the outcome of surgical
procedures aimed at chronic pain relief can be strongly influenced
by psychological and emotional factors. This approach, termed
"presurgical psychological screening" (PPS) uses interview and
testing techniques to identify emotional, behavioral, and
psychosocial difficulties which have been demonstrated to
negatively impact surgical outcome. Studies show that even patients
with clearly identifiable pathophysiology may respond poorly to
surgery, due to issues such as pain sensitivity, medication
dependence, rewards for pain behavior and personality style. Thus,
some insurance carriers, rehabilitation nurses and state worker's
compensation systems are encouraging, or even requiring,
presurgical psychological screening in cases of surgery designed to
relieve chronic pain. The first to present a comprehensive, unified
approach to PPS in chronic pain syndromes, this text is designed to
provide the behavioral health practitioner, as well as the trainee,
with all the tools and information necessary to conduct PPS
evaluations. It identifies a multitude of risk factors for poor
surgical outcome and reviews research associated with each risk
factor. Hands-on techniques for eliciting information from the
patient about risk factors is also detailed. Toward this end, the
practice guide also contains a number of forms and session outlines
which can be directly utilized, or which can be altered to fit
readers' needs. Models for weighing and combining surgical outcome
risk factors are also provided. Thus, practitioners are able to
reach valid and reliable predictions of surgical results. Finally,
the text provides outlines of psychological interventions which can
facilitate surgical outcome as well as surgical treatment
alternatives. Upon completion of this practice guide, readers
should be able to begin providing PPS evaluations which are
scientifically valid, clinically sound, and which result in
significant overall improvement in the treatment of chronic pain
syndromes.
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