Longnecker's Anesthesiology > Part 8. Care of the Chronic Pain Patient > Chapter 92. Medical Management of Chronic Pain Marc A. Huntoon, MD

Pain Rehabilitation Strategies

"Anesthesiologists are extremely well prepared in the application of pharmacologic and interventional principles because of excellent command of the perioperative care of complex patients. However, chronic pain patients often defy treatment in a strictly biomedical model of care. The biomedical model presupposes a definable injury, disease, or process that can be treated.¹⁵⁶ Unfortunately, despite extensive and often expensive evaluations to explain patient pain syndromes, a precise diagnosis cannot always be made. Furthermore, patients presenting to a chronic pain treatment facility have often tried multiple therapies without significant improvement. Thus, a biopsychosocial model of care, wherein the patient is treated wholistically, understanding their reaction, beliefs, and coping mechanisms regarding the physical pain within the broad context of their work and family and social environments, often is more successful.Catastrophizing can be summarized as a negative cognitive belief state associated with actual or potential pain experiences. Three major attributes of catastrophizing are (1) magnification, (2) rumination, and (3) helplessness...."