Heath B. McAnally – författare

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.

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.