Conclusions

Acute and post-operative pain has emerged as an important issue because ethics aspects and associated morbidity and mortality. Substantial progress in understanding peripheral, spinal cord and brain mechanisms involved in acute post-operative pain continues to be made with important consequences for treatment. The diagnosis and treatment of the cause of acute pain must always have high priority and post-operative pain management is an important goal in order to optimise medical care. Improved understanding of the pharmacology of the analgesics and the development of new techniques for analgesic administration have greatly enhanced the ability of medical doctors to success manage patients in pain. For some post-operative conditions the success of pharmacological strategies is remarkable, especially in adult patients. Even for children and adolescent with the most severe pain early evidence shows that it may be possible to reduce the impact of pain on the lives of the patients and their families. More action is necessary. Firstly, more paediatric centres are needed, to develop specific post-operative pain programmes. Secondly, collaboration between centres will be necessary to provide large enough samples of patients with the various pain conditions, considering the lack of data on this field. Finally, we must considerer that the incidence of post-operative pain in children is similar to that of adults but that our knowledge of how to help children cope with acute pain is underdeveloped. The psychological and physiologic uniqueness of children must not be forgotten. Cooperation and communication between the anaesthesiologist, surgeon, and paediatrician are essential for successful anaesthesia and pain management. The introduction of acute pain services has been shown to improve postoperative pain relief, but it is foreseeable that their role should expand and integrate into general perioperative care (Box 4). For these reasons the alleviation of pain and anxiety in post-operative patients is actually a high priority of all post-operative services and all persons involved in perioperative management of these patients are very much a part of ''continuity of care'' concept to obtain effective pain relief.

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