Prehabilitation Reimagined as Policy: A Multidimensional Framework to Reduce Pain, Opioid Use, and Surgical Risk

Int J Spine Surg. 2025 Oct 27:8807. doi: 10.14444/8807. Online ahead of print.

ABSTRACT

BACKGROUND: Traditional surgical prehabilitation emphasizes biomechanical conditioning. In a pain landscape shaped by opioid exposure, trauma histories, and psychosocial distress, this reductionist approach is insufficient.

OBJECTIVE: To propose a multidimensional, whole-person framework for perioperative readiness that integrates neurobiological mechanisms with practical clinical and policy levers.

FRAMEWORK: Five synergistic domains-biological, psychological, social, spiritual, and existential-address discrete readiness deficits linked to dopaminergic tone, central sensitization, stress reactivity, connection, and meaning. Each domain is mapped to mechanisms, evidence-based interventions (eg, physical therapy, cognitive behavioral therapy/screening, social support linkage, chaplaincy, reflective practices), and relevant billing structures (Current Procedural Terminology Healthcare Common Procedure Coding System, International Classification of Diseases, 10th Revision Z codes).

IMPLEMENTATION: The model operationalizes a deliverables-based pathway-screen → triage → targeted interventions → outcome tracking-monitoring pain, function, opioid exposure (morphine milligram equivalents), length of stay/readmissions, depression and anxiety (Paitent Health Questionnaire-4), and pain catastrophizing (Pain Catastrophizing Scale). It aligns with risk-adjusted payment models and can be embedded within enhanced recovery after surgery programs.

CLINICAL SIGNIFICANCE: Reframing prehabilitation as neurobiologically informed whole-person readiness provides a low-risk, nonpharmacological strategy to reduce suffering, improve engagement, enhance postoperative pain control and recovery, and decrease opioid reliance.

LEVEL OF EVIDENCE: 5 (Expert Opinion). This perspective integrates neurobiological and behavioral theory with policy and billing frameworks to enable hypothesis-generating implementation and outcomes research.

PMID:41145214 | DOI:10.14444/8807