Key messages

• Pain initiates a wide range of physiological and psychological alterations that initially help the body to maintain homeostasis. However, these effects may become harmful if pain remains untreated or undertreated and may cause morbidity and mortality.

• Pain from surgical trauma consistently elicits increased sympathetic nervous system activity and adrenal catecholamine secretion. This leads to enhanced myocardial oxygen consumption which can be detrimental in patients with underlying cardiac disease.

• The neuroendocrine stress response after painful trauma is characterized by an increased secretion of catabolic hormones and a decreased secretion of anabolic hormones. Hyperglycemia, increased protein breakdown, and a negative nitrogen balance are the consequences.

• The transition from acute to chronic pain may critically depend on disturbances of intrinsic control mechanisms as well as on effective therapeutic measures initiated at the earliest possible time.

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