Preemptive analgesia: An ounce of prevention still may be worth a pound of cure
Year: 2000
Type: article
Abstract: Pain might be the sensory experience most capable of inducing plasticity of the nervous system. Laboratory studies show how a painful stimulus can initiate a cascade of neural events that expand somatosensory receptive fields and increase their sensitivity. 1 Woolf CJ Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983; 306: 686-688 Crossref PubMed Scopus (1659) Google Scholar Preemptive analgesia seeks to lessen the impact of painful stimuli by preventing or limiting the central sensitization induced by this cascade by initiating an analgesic regimen before the onset of painful stimuli. 2 McQuay HJ Pre-emptive analgesia. Br J Anaesth. 1992; 69: 1-3 Crossref PubMed Scopus (201) Google Scholar , 3 Wall PD The prevention of postoperative pain. Pain. 1998; 33: 289-290 Abstract Full Text PDF Scopus (550) Google Scholar , 4 Woolf CJ Chong MS Preemptive analgesia: Treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993; 77: 362-379 Crossref PubMed Scopus (1411) Google Scholar However, translating this scientifically appealing concept to the bedside has proven problematic and, after a decade of studies, the utility of preemptive analgesia as a viable clinical tool is still debated. This uncertainty is reflected in the critical review article by Taylor and Brennan, 5 Taylor BK Brennan TJ Preemptive analgesia: Moving beyond conventional strategies and confusing terminology. J Pain. 2000; 1: 77-84 Abstract Full Text Full Text PDF Scopus (27) Google Scholar who question the efficacy of preemptive analgesia and make it evident that many negative or equivocal clinical studies of preemptive analgesia have been conducted. These authors introduce several definitions through which they then filter a considerable, complex, and conflicting literature to conclude that “Preemptive analgesia appears to have little utility …” However, their definitions are more analogous to typical laboratory experiments than actual clinical situations; therefore, any conclusions drawn in this manner might be of limited clinical relevance. At the same time, Taylor and Brennan make it frustratingly clear that our approach to studying and implementing preemptive analgesia must evolve.
Source: Journal of Pain
Author: Allan Gottschalk
Institution: University of Pennsylvania
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,180
OpenAlex ID: W2138208380