Expert: JM Starkman, MD - 8/9/2011

Question
Doctor,
What are your thoughts on pre-emptive analgesia with NSAIDs for surgical pain?

Thanks in advance for your response.

Answer
Pre-emptive analgesia has worked out well for the researchers getting mileage out of publishing academic articles about it, but as far as everyone else goes, there's no concensus about its effectiveness.  But pre-emptive analgesia was never about NSAIDs, but local anesthetics and opioids instead!

Most post-operative surgical pain (as is most pain in general) is due to inflammation--the body's response to injury. So, NSAIDs will be important in treating that and should be carefully employed when indicated.  Since this has nothing to do with the gate theory of pain though,  the original concept  of 'pre-emptive analgesia' to get published and generate research dollars does not seem to apply here.  Re-spinning the discussion for NSAIDs is probably originating with the pharmaceutical industry attempting to crowbar a new indication out of existing drugs approved for other use$$.


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