Pre-emptive analgesia: an unsolved problem

Preemptive analgesia studies have provided mixed results, some showing benefit and others no benefit, whereas others have shown small differences that are probably not clinically useful. There is no consensus yet about whether preemptive analgesia is a clinically useful tool. This review examines the mechanisms of preemptive analgesia before surveying the recent literature. A new definition of preemptive analgesia is proposed that accommodates the need for a broader definition. Recently published trials confirm that confusion exists about what preemptive analgesia is, how to distinguish it from simple analgesia, and how to design trials that truly assess preemptive analgesia, defined as analgesia that is capable of modifying the central excitatory responses.