ABSTRACT
The importance of optimizing the clinical management of acute pain has been increasingly recognized (Carr & Goudas, 1999). For example, in the context of surgery, providing adequate acute pain control minimizes length of stay and improves outcomes (Kiecolt-Glaser, Page, Marucha, MacCallum, & Glaser, 1998; Ballantyne et al., 1998). Several factors may account for these beneficial effects. Postsurgical pain and associated psychological stress can have negative effects on the immune system and endocrine function that impact on recovery (Kiecolt-Glaser et al., 1998). Moreover, uncontrolled nociceptive input may over time result in pathological changes in the central nervous system that could contribute to pain chronicity (e.g., Gracely, Lynch, & Bennett, 1992). This central sensitization phenomenon may help explain findings that greater acute pain severity predicts transition to chronic pain (Murphy & Cornish, 1984), and that earlier aggressive management of acute pain may reduce the incidence of postsurgical chronic pain (Sen turk et al., 2002). Overall, the results just described underscore the fact that effective management of acute postsurgical pain can have a significant impact on outcomes. Adequacy of pain control may also be an important issue to consider with regard to less invasive painful medical procedures. Optimal acute pain control in this latter context may increase tolerability of necessary procedures and impact on willingness to engage in similar procedures in the future (e.g., Wardle, 1983).
