Page 11 Acute Pain Management

Contents
FOREWORD......................................................................................................................... iv

INTRODUCTION................................................................................................................... vi
SUMMARY OF KEY MESSAGES............................................................................................xix
1. PHYSIOLOGY AND PSYCHOLOGY OF ACUTE PAIN .......................................................... 1
1.1 Applied physiology of pain ........................................................................................... 1
1.1.1 Definition of acute pain.........................................................................................1
1.1.2 Pain perception and nociceptive pathways...........................................................1 CONTENTS
1.1.3 Neuropathic pain...................................................................................................6
1.2 Psychological aspects of acute pain.............................................................................. 6
1.2.1 Psychological factors .............................................................................................7
1.2.2 Acute pain settings................................................................................................8
1.3 Progression of acute to chronic pain............................................................................. 9
1.3.1 Predictive factors for chronic postsurgical pain ..................................................11
1.3.2 Mechanisms for the progression from acute to chronic pain .............................12
1.4 Pre‐emptive and preventive analgesia ....................................................................... 12
1.5 Adverse physiological and psychological effects of acute pain.................................... 15
1.5.1 Acute pain and the injury response.....................................................................15
1.5.2 Adverse physiological effects ..............................................................................16
1.5.3 Pain and analgesia: effects on injury‐induced organ dysfunction.......................19
1.5.4 Acute rehabilitation and ‘fast‐track’ surgery.......................................................20
1.5.5 Adverse psychological effects .............................................................................21
1.6 Pharmacogenomics and acute pain ............................................................................ 21
1.6.1 Loss of pain sensation .........................................................................................22
1.6.2 Reduced sensitivity to pain .................................................................................22
1.6.3 Drug metabolism.................................................................................................23
References ......................................................................................................................... 25

2. ASSESSMENT AND MEASUREMENT OF PAIN AND ITS TREATMENT ............................. 34
2.1 Assessment................................................................................................................ 34
2.2 Measurement ............................................................................................................ 35
2.2.1 Unidimensional measures of pain.......................................................................36
2.2.2 Functional impact of acute pain..........................................................................38
2.2.3 Multidimensional measures of pain....................................................................38
2.2.4 Patients with special needs.................................................................................39
2.3 Outcome measures in acute pain management.......................................................... 40
2.3.1 Outcome measures .............................................................................................40
References ......................................................................................................................... 42

Acute pain management: scientific evidence xi