PeriOperativePain.com is an academic, educational, non-commercial website devoted to teaching physicians, nurses, other health providers, and patients the latest concepts in postoperative pain management.The major obstacle to improving postoperative pain relief is the fact that the field is dominated by an outdated conceptualization of the neuroanatomy of pain. We all have been taught that pain is the endproduct of a passive transmission system that faithfully transmits a peripheral signal to the spinal cord and up to a pain center in the brain. (1) This view is straightforward, simple to understand, and quite widespread. The only problem with this model is that it is wrong, and has led to inadequate and inappropriate management of postoperative pain. Most surgeons base their treatment of out-patient postoperative pain on oral opioid medication. The inappropriate use of opioids has led to what many authors call and "Opioid Epidemic", and the CDC in 2013 stated that overdoses of legitimately prescribed opioids now kills more Americans than heroid or morphine.
Neuroanatomical research has demonstrated that the pain transmission from periphery to brain is a highly active and modulated system. There is both positive and negative feedback along the entire system, but predominately at the spinal cord and brain levels. This occurs via mechanisms that include synaptic feedback, neurotransmitter modulation, spinal and supraspinal sensitization, and up- and down-regulation of neuroreceptor molecules. The system is anything but a "passive transmission system that faithfully transmits a peripheral signal to the spinal cord and up to the brain"! Further information on neuroanatomy is at Core Knowledge.
The purpose of this site is to teach the most current understanding of the neuroanatomy of pain and to report current scientific studies of postoperative pain. It is the opinion of the Editorial Board that changes in the treatment of postoperative pain can be made if health care providers are given a foundation of neuroanatomy plus studies from their own fields demonstrating that excellent pain management is possible. Our patients deserve nothing less than the absolute best pain management, and it is the goal of this site to provide the information to enable health care providers to achieve this.
The site is written and maintained by David L. Nelson, MD, an orthopedic hand surgeon.
The members of the original Editorial Board were:
This page was written by David L. Nelson, MD. It was first posted on 9/27/01 and last updated on 5/14/2013.
1 Katz J: Timing of treatment and preemptive analgesia. In: Rowbotham DJ and MacIntyre PE, eds, Acute Pain,Arnold, London, 2003.