Neuropathic pain in the perioperative period

The presence of neuropathic pain in the postoperative period may be associated with unnecessary suffering, particularly if the diagnosis is not made and treatment modalities chosen are ineffective. It is likely that inadequate management of acute pain may set the scene for progression to a chronic pain state. The underlying neurobiological mechanisms whereby short-term stimuli may lead to long-term plasticity and structural changes in the nociceptive pathways are now being unraveled. The possibility arises that acute, intensive intervention may avoid or significantly reduce the development of these changes and subsequent chronic pain. Early diagnosis and treatment becomes a priority. There is a need for further research in this area to determine whether or not such theoretical potential can be turned to therapeutic advantage.