By Raymond S. Sinatra, Oscar A. de Leon-Cassasola, Eugene R. Viscusi, Brian Ginsberg

This textbook is written as a accomplished evaluate of acute soreness administration. it truly is designed to steer clinicians via a magnificent array of alternative suggestions to be had to them and to sufferers. within the final decade there was a flurry of curiosity within the quantity to which acute ache can develop into power ache, and the way we'd lessen the prevalence of such chronicity. This review covers quite a lot of remedies for ache administration, together with the anatomy of soreness pathways, the pathophysiology of serious discomfort, ache evaluation, healing guidance, analgesic thoughts, association of discomfort providers, and the position of anesthesiologists, surgeons, pharmacists, and nurses in supplying optimum care. It additionally discusses using patient-controlled analgesia and the way this can or is probably not potent and necessary.

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Nociceptive-specific activation of ERK in spinal neurons contributes to pain hypersensitivity. Nat Neurosci. 1999;2(12):1114–1119. 84. Fang L, Wu J, Lin Q, Willis WD. Calcium-calmodulin-dependent protein kinase II contributes to spinal cord central sensitization. J Neurosci. 2002;22(10):4196–4204. 85. Rothman SM, Olney JW. Excitotoxicity and the NMDA receptor– still lethal after eight years. Trends Neurosci. 1995;18(2):57–58. 86. Lipton SA, Nicotera P. Calcium, free radicals and excitotoxins in neuronal apoptosis.

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The cerebral cortex, hypothalamus, thalamus, PAG, nucleus raphe magnus (NRM), and locus coeruleus (LC) all send descending axons that synapse with, and modulate pain transmission in, noxious cells located in the brainstem and spinal cord dorsal horn. Components of the descending system that play critical roles in modulating pain transmission include the previously mentioned endogenous opioid system, the descending noradrenergic system, and serotonergic neurons. The PAG is an enkephalinergic brainstem nucleus responsible for both morphine- and stimulation-produced analgesia.

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