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MODERNISING OUR APPROACH TO POST‐OPERATIVE PAIN
Author(s) -
Jones D.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04126_6.x
Subject(s) - medicine , denial , psychosocial , presentation (obstetrics) , intensive care medicine , chronic pain , psychotherapist , physical therapy , psychiatry , surgery , psychology
Pain is not a single entity, but many complex biological processes combined with psychosocial responses. Therapies therefore have to be multimodal. Single analgesics suit only a few. Although promoting positive thoughts and interactions with team members is important, this presentation will bias towards biological factors. Reducing unnecessary postoperative pain suffering starts long beforehand in elective cases. Mounting evidence, of long‐lasting (‘chronic’) pain following procedures needs accurately portraying to patients for informed consent. Denial of these facts causes later problems. Appropriate preparation reduces beliefs that ongoing pain means an error. Once embarking on a procedure, measures prior to nociceptive surgical stimulus contribute to reduced postoperative pain, although robust evidence for pre‐emptive analgesia in many situations remains elusive. But lack of evidence does not mean evidence against. A perfect single solution does not exist. Illustrating with pathophysiology of pain and of nerve disturbance, pharmacology and genetic information, this presentation discusses rationalizing and combining common measures, why generous morphine doses don’t always work, and why some results are less than expected.