Perioperative pain relief has taken on a new dimension in recent years; that of helping to prevent chronic pain after surgery. Knowledge of pain mechanisms, the importance of both peripheral and central sensitisation and descending inhibitory and facilitatory pathways from the midbrain to spinal cord, have advanced our understanding of how pain may persist after surgery. There is advancing knowledge about the up-regulation and down-regulation of opioid receptors, opioid tolerance and hyperalgesia, and its similarities to neuropathic pain.
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