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The book begins with a public health/epidemiologic examination of
the situation, with a systematic view of the problem based on
classic (infectious disease) epidemiologic principles applied to
this behavioral health issue. This application is expanded to take
into account the fact that unlike most epidemics in our species'
history, a unique factor that must be accounted for in any public
health analysis is that the host (opioid-dependent/misusing
patient) is generally not under sufficiently strong motivation to
avoid the disease. The introduction concludes with a survey of
recent containment approaches, categorized epidemiologically by
target (agent, vector, host.) The remainder of the book is
organized according to this framework, addressing agent,
vector/transmission and host, respectively. Sections Three and Four
comprise the major focus of the book, and are dedicated primarily
to practical education for primary care providers in preventing
opioid use disorder, and overcoming it after the fact.
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.
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