Evaluating the complex chronic pain patient.
The evaluation of the complex chronic pain patient should be different than for the patient with a simple pain problem. The former requires a team approach. It is important that the neurosurgeon contemplating a pain-relieving operation get the best information that is likely to have an impact on outcome. This should include the following: 1. Some way to extract the appropriate information contained in the patient's medical records. 2. Physical factors that have a negative impact on prognosis. 3. Psychologic information, including return-to-work decisions, medication use issues, meaning of prior successes, negative environmental factors, codependency issues, secondary gains and their impact, presence of pain games, negatively acting financial considerations, impact of depression, presence of poor role models, impact of pain on general functioning, and the patient's future plans. Consider that just like a successful operation is a symphony of relatively simple harmonious parts, so, too, is the assessment of the complex chronic pain patient. The complexity of the patient and her or his predicament should not impair your ability to understand her or his real needs. The appropriate assessment of the patient requires that issues other than the pain itself be factored into the decisions about interventions. In the end, it is not appropriate to suggest afterward that psychosocial factors were the major cause for a poor result when nothing had been done about the same factors that had been present before the procedure.