Pain results from many insults, e.g. trauma, invasive procedures, specific organ disease and inflammatory processes. Pain relief is necessary for physiological and psychological reasons:

• Anxiety and lack of sleep.

• Increased sympathetic activity contributing to an increased metabolic demand.

• The capacity of the circulation and respiratory system to meet the demands of metabolising tissues may not be adequate.

• Myocardial ischaemia is a significant risk.

• The endocrine response to injury is exaggerated with consequent salt and water retention.

• Physiological attempts to limit pain may include immobility and muscle splinting and consequent reductions in ventilatory function and cough.

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