Putting It All Together

Joint behavioral health and medical care is required for optimal success in preoperative optimization of the chronic pain patient. This effort basically comprises lifestyle modification issues, and habit breaking and replacement do not come easily. Physical and psychological dependence on tobacco, alcohol, and opioids adds to the complexity and requires skilled and individualized intervention. Nonetheless, some basic principles, goals and a template/plan for multidimensional “baby steps” can be implemented in every case. Given that many of these variables (e.g., sleep, exercise, diet, kinesiophobia, etc.) are interdependent, such a multidimensional approach is preferred in terms of efficacy. Correspondingly, current forward-thinking charters such as the US National Pain Strategy recognize that the mainstream passivity-inducing and frequently opioid-reliant chronic pain management culture with its failure to encourage biopsychosocial-spiritual health and proactive solutions fosters dependence on reactive efforts. It is no wonder patients suffering with chronic pain in this country should pursue stronger drugs, more procedures and surgery, which in the absence of improved baseline mind-body health status all too often results in worsening of their pain syndrome and opioid dependence. The individual patient and the system at large require recalibration, focusing on what our forebears called “fitness for surgery.”