====== Biopsychosocial ====== see [[Biopsychosocial model]]. ===== Biopsychosocial variables ===== Physical function, sleep disturbance, [[fatigue]], pain interference, [[depression]], and [[anxiety]], ---- [[Chronic pain]], particularly chronic [[low back pain]], is a common disabling condition with high costs and burdens to [[society]]. The biopsychosocial model may provide a framework in which chronic low back pain may be viewed to guide new and emerging clinical care models to achieve the Triple Aim in this field of care ((Gliedt JA, Mardian AS. Making strides toward achieving the Triple Aim in the treatment of chronic low back pain with a biopsychosocial guided approach. Musculoskeletal Care. 2019 Aug 16. doi: 10.1002/msc.1423. [Epub ahead of print] PubMed PMID: 31419010. )). ---- Goudman et al., proposed a shift in educational intervention from a biomedical towards a [[biopsychosocial]] approach for people scheduled for lumbar surgery. [[Pain neuroscience education]] (PNE) is such a biopsychosocial approach that aims at decreasing the threat value of [[pain]] by reconceptualizing pain and increasing the patient's knowledge about pain. In a paper, they provide a clinical [[perspective]] for the provision of perioperative PNE, specifically developed for patients undergoing surgery for [[lumbar radiculopathy]]. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for post-surgical pain and how to cope with it ((Goudman L, Huysmans E, Ickmans K, Nijs J, Moens M, Putman K, Buyl R, Louw A, Logghe T, Coppieters I. A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective. Phys Ther. 2019 Mar 28. pii: pzz053. doi: 10.1093/ptj/pzz053. [Epub ahead of print] PubMed PMID: 30921465. )). ---- Only 8 studies have investigated the [[Aneurysmal subarachnoid hemorrhage epidemiology]] in the [[United States]]. In the first investigation in [[Indiana]], which has some of the highest rates of [[tobacco]] [[smoking]] and [[obesity]] in the nation. Ziemba-Davis et al. prospectively identified 441 consecutive patients with aSAH from 2005 to 2010 at 2 [[hospital]]s where the majority of cases are treated. [[Incidence]] calculations were based on US Census populations. Epidemiologic variables included [[demography]]; [[risk factor]]s; Hunt and Hess scale; Fisher grade; number, location, and size of aneurysms; treatment type; and complications. The overall incidence was 21.8 per 100,000 population. Incidence was higher in women, increased with age, and did not vary by race. One third to half of the patients were hypertensive and/or smoked cigarettes at the time of [[ictus]]. Variations by count were partially explained by Health Factor and Morbidity Rankings. Complications varied by treatment. These findings deviate from estimates that 6-16 per 100,000 people in the United States will develop aSAH and are double the incidence in a [[Minnesota]] population between 1945 and 1974. The results also deviate from the worldwide estimate of 9.0 aSAHs per 100,000 person-years. The predictive value of variations in Health Factor and Morbidity Rankings implicates the importance of future research on multivariate biopsychosocial causation of aSAH ((Ziemba-Davis M, Bohnstedt BN, Payner TD, Leipzig TJ, Palmer E, Cohen-Gadol AA. Incidence, epidemiology, and treatment of aneurysmal subarachnoid hemorrhage in 12 midwest communities. J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):1073-82. doi: 10.1016/j.jstrokecerebrovasdis.2013.09.010. Epub 2013 Oct 19. PubMed PMID: 24144595. )).