The pathophysiology of pain is a complex process that varies according to duration (eg, acute, chronic) or type (eg, nociceptive, neuropathic, psychogenic). Perioperative nurses should understand the pathways that lead to pain to better assist in managing patients' pain symptoms. Approaching pain from a patient-centered stance includes acknowledging that pain is defined entirely by the subjective experience of the patient, which may not be proportional with the level of tissue damage. This article provides a brief description of the pathophysiology of pain and the components of nociceptive and neuropathic pain pathways to aid the perioperative nurse in pain management.

In order to determine whether opioid-naive patients at risk for respiratory depression are better monitored with either capnography or pulse oximetry and respiratory-rate assessment, the authors conducted a randomized, prospective trial. In 54 opioid-naive postoperative orthopedic patients at one hospital, capnography resulted in greater detection of respiratory depression, and the authors conclude that capnography may be more appropriate for use with postsurgical high-risk patients taking opioids on the general care nursing unit. Capnography's sensitivity in the detection of pauses in breathing in the sedated patient may have the added advantage of indicating those patients who may be at risk for obstructive sleep apnea. Further research is needed to confirm these results.

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