Preemptive analgesia II: recent advances and current trends

Abstract

Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multimodal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy.

Preemptive Analgesia: Is Pain Less Costly When You Pre-Pay For It?

“…4,[8][9][10] This treatment concept is based on the idea that chronic persistent pain states, including primary and secondary hyperalgesia, allodynia, inflammatory pain, neuropathic pain, and functional somatic syndromes, are all triggered by some combination of peripheral or A central sensitization of neurons in the pain pathway. 4,[8][9][10] Preemptive analgesia is defined as any antinociceptive pain treatment that prevents the establishment of this altered central processing of painful input from sites of injury. 4,[8][9][10] The best example of preemptive analgesia is in its use for postoperative pain, in which the onset of pain can be predicted, and for which animal models have established the validity of this concept.…”

“…4,[8][9][10] Preemptive analgesia is defined as any antinociceptive pain treatment that prevents the establishment of this altered central processing of painful input from sites of injury. 4,[8][9][10] The best example of preemptive analgesia is in its use for postoperative pain, in which the onset of pain can be predicted, and for which animal models have established the validity of this concept. 4 However, in clinical trials of postoperative pain, the effects of preemptive analgesia have been inconsistent, perhaps because the analgesia tested did not always fully precede, adequately block, or completely outlast the painful stimuli that accompany tissue injury from surgery.…”

“…4 However, in clinical trials of postoperative pain, the effects of preemptive analgesia have been inconsistent, perhaps because the analgesia tested did not always fully precede, adequately block, or completely outlast the painful stimuli that accompany tissue injury from surgery. [8][9][10] Also, single drugs may not be as effective as multimodal pain therapies. 4 Thus, future testing of preemptive analgesia may combine anti-inflammatory agents, to block pain transduction peripherally, with regional anesthesia, to block pain transmission centrally, using central analgesics such as opiates, dual serotonin and norepinephrine reuptake blockers, and voltage sensitive calcium channel (VSCC) modulators of α 2 δ sites.…”

“…4 Thus, future testing of preemptive analgesia may combine anti-inflammatory agents, to block pain transduction peripherally, with regional anesthesia, to block pain transmission centrally, using central analgesics such as opiates, dual serotonin and norepinephrine reuptake blockers, and voltage sensitive calcium channel (VSCC) modulators of α 2 δ sites. 4,[8][9][10][11][12] Rescue Analgesia That Intercepts Physical Symptoms?…”

Influência da codeína, associada ou não ao anestésico local, na duração do bloqueio sensitivo, motor e proprioceptivo do nervo ciático de rato

“…A condição mais importante para o estabelecimento de uma analgesia preemptiva efetiva é um nível alcançado de antinocicepção antes da promoção da injúria e a continuação deste nível de analgesia no período pós-injúria para que previna a sensibilização central durante a fase inflamatória (Kelly et al, 2001).…”