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Prevention of chronic postsurgical pain: the ongoing search for the holy grail of anesthesiology.

*Uniformed Services University AND Johns Hopkins School of Medicine, Dept. of Anesthesiology and Critical Care Medicine †Department of Anesthesiology and Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
Anesthesiology (Impact Factor: 6.17). 02/2013; 118(2):241-3. DOI: 10.1097/ALN.0b013e31827d4129
Source: PubMed
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    ABSTRACT: Pain from surgical procedures occurs as a consequence of tissue trauma and may result in physical, cognitive, and emotional discomfort. Almost a century ago, researchers first described a possible relationship between intraoperative tissue damage and an intensification of acute pain and long-term postoperative pain, now referred to as central sensitization. Nociceptor activation is mediated by chemicals that are released in response to cellular or tissue damage. Pre-emptive analgesia is an important concept in understanding treatment strategies for postoperative analgesia. Pre-emptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively but not after surgical incision. Additional research in pre-emptive analgesia is warranted to better determine good outcome measurements and a better appreciation with regard to treatment optimization. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics.
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