Authors: Health Mcanally: MD, MSPH, Lynda W Freeman: Ph.D, Beth Damall: Ph.D
ISBN: 9780190920142
Soft Copy available on Amazon/Kindle
Published in August 2019 by Oxford University Press
This book is a combination of pain medicine and psychology. It targets optimising the chronic pain before surgery to prevent the development of chronic post-surgical pain and to prevent the flair of acute on chronic pain episodes.
The book has 11 chapters.
First chapter describes the scope of the problem, the economic burden and related complications. There is an overview of consequences of pain chronification and opioid use. Multiple papers are cited with detailed results on pre-op and post-op problems of opioids with effects on length of stay and success rates of surgery
2nd chapter talks about the rationale and the process of optimization. It introduces the ‘preoperative optimization programme’, which the authors have developed for the patient struggling with chronic pain. The rest of the book unpackages that in greater detail. There is an introduction and history of Transitional Pain Services, Prehabilitation and 10 week programme. The 10 week time frame focuses on habit changing and optimising opioid doses.
Then the book begins to form a pragmatic and therapeutic perspective with a brief overview of what is commonly called motivational interviewing and its role in facilitating the life style /behavioural changes. It describes the transtheoretical model of behavioural changes described by Prochaska and DiClemente. There is a description of Miller and Rollnick’s strategic level orchestration of motivational interviewing. Multiple article are cited along with Cochrane review in support of this.
“Why doesn’t pain serve as the ultimate motivator for more people?”
Motivation, and its different types are given in detail along with its relationship to neurobiology. It explores the interpersonal variability elements and also categorises it ethically/morally and religiously.
The critical role of habits in directing behaviour with understanding of tension and cooperation between reflective and reflexive process is important for preoperative optimization. Factors ruling habit psychology are also important in designing a pre-op optimization programme for a particular patient.
There is a full evidence based chapter on catastrophizing, fear and anxiety scales and their effects on surgical outcome, and CBT as a suggested treatment, However, inclusion of scores, scale calculation and parameters would have been more interesting for the readers. Clinical toolkit for enhancing self-regulation in perioperative context in a tabulated form is added by the author.
There is an interesting chapter on sleep optimization. This chapter has familiar things like biological clock and circadian rhythm, but there is description of a term used Zeitgebers which means things that help reset circadian rhythm.
A detailed account of the effect of physical activity and nutrition on outcome of surgery and chronic pain has also been given. Tobacco consumption and cessation related consequences on chronic pain are also part of this mind game of optimization.
Opioid biology, pharmacology and addictionology perspectives are discussed with recommendations from literature. A short summary of naltrexone, methadone and buprenorphine is mentioned.
The last page is the summary of the book
In summary, it 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. Read the book only if you want to explore the psychological side of pain and mindfulness basics.
Romana Shaida Durrani,
CCST, DPMCAI, EDAIC, FCAI, DA, DHP&M, MBBS
Consultant Anaesthesia & Pain Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore (Pakistan)
E-mail: romanadurrani@gmail.com
DOI: 10.35975/apic.v23i4.1186