Acute and postoperative pain. Management from a primary care perspective.

Most pain is controllable. Patient education and careful intraoperative technique are useful prophylactic measures. Simple analgesics and non-steroidal anti-inflammatory drugs reduce pain, fever, and inflammation and are well tolerated when dosing guidelines are followed carefully. In patients whose pain is not controlled with these measures, the addition of a weak narcotic analgesic is reasonable. If relief is still inadequate, a stronger narcotic alone or in combination with another analgesic may be needed. The advent of patient-controlled analgesia has diminished some of the objections to continuous intravenous infusion of narcotics. Various acute-pain syndromes respond to blockade of the sympathetic or somatic neural pathways. Knowledge of the appropriate anatomic structures and careful technique are mandatory with this method. Moreover, it should be considered only one part of a comprehensive treatment plan.