Pre-emptive analgesia

Something I think of note

Pre-emptive analgesia

The concept of pre-emptive analgesia entered the veterinary profession perhaps thirty years ago. It revolutionised treatment. Our patients went home happy. People who had had a pet operated on before were amazed at the improvement.

Basically, the principle is that stopping the pain before the pain fibres fire is vastly more effective that trying to stop them after they have fired. It is also known that in many cases the pain pathway utilises several nerves, so blocking as many as possible makes sense.

We started giving pre-med injections of various anti-inflammatories. Patients that once would have gone home depressed and reluctant to move for a few days were now going home as if nothing happened.

This principle is well established and effective. What confuses me is that it has not been taken up by the dental and medical professions. Some years ago, I had to have some extra bone instilled into my frontal sinus to support the dental implants I was getting. The surgery involved meant that my upper gum had to be reflected (pulled back) to access the sinus. I was warned that it would be uncomfortable for three or four days afterwards. In the hour before the procedure, I took one paracetamol and codeine tablet and one ibuprofen and codeine tablet. This blocked three different pain pathways. Both tablets were and are available at the local pharmacy. The chemist will warn you not to take paracetamol and ibuprofen together. You may even have to make two trips. I had no post procedure discomfort and was able to eat dinner that night. Why was it good enough to tell me I would have serious discomfort but not provide the simple remedy?

It is the same with what I call human surgery. We are given an injection to sedate us and lower the amount of anaesthetic required. How difficult would it be to include some analgesia? How difficult would it be to give some analgesia before operating on the patient?

The problem is I think that a paradigm shift is required. The medical profession feel that some pain is acceptable and they anaesthetise you for the major procedures. Almost none of the anaesthetic agents have any pain-killing effect. Why does the medical profession not recognise that in this day and age they should be minimising that ‘some pain’, especially when it is so easy to do? I know that when I had major abdominal surgery four years ago, I woke up with an array of tiny needles in my back (pumping in some sort of pain-killer and I was given Oxycodone, but I hallucinated, so they gave me morphine, but I hallucinated, so they gave me paracetamol. I had serious discomfort for some days. Had I been given a pre-med of NSAIDS and codeine I would have been a lot happier, and probably recovered faster. All that analgesia was in effect after the fact. The pain fibres had fired. Now they were trying to dampen them down. Why not take it one step further and stop them firing in the first place.