[Per- and postoperative pain]

We have made a huge amount of progress over the last decade, but we must continue to clear a way through the undergrowth. Per- and postoperative pain is typical of acute pain and is characterized by an excess of nociception due to tissue injury, visceral distention or disease. It contrasts with chronic pain which has been going on for 3 to 6 months. PATHWAYS OF PAIN: We know that the spinothalamic cord is involved in nociceptive activity. Two pathways are of great interest. One ends in a nucleus of the hypothalamus and the second in the amygdala. Both are involved in affective and emotional activity. Treatment of postoperative pain requires first that one be aware that pain is a reality and secondly that it must be assessed with various scales. Only then can the therapeutic strategy set about using the different methods available. Strategy must be continuously assessed to improve its efficacy. Different kinds of treatment can be used during the per- and postoperative period including enteral (paracetamol, nonsteroidal analgesic and antiinflammatory drugs (NSAIDs)) or parenteral (paracetamol, NSAIDs, morphine or similar) analgesic drugs. Local anesthesia seems however to be more effective. Several factors are involved in per- and postoperative pain. Its treatment is based on comprehensive team work in which each person represents a link in the therapeutic chain. For the future, we can expect to see the appearance of new drugs, processes or associations able to prolong postoperative analgesia.