British medical bulletin
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Transmission of pain signals evoked by tissue damage leads to sensitization of the peripheral and central pain pathways. Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce this sensitization. Owing to this 'protective' effect on the nociceptive system, pre-emptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery. ⋯ The only way to prevent sensitization of the nociceptive system might be to block completely any pain signal originating from the surgical wound from the time of incision until final wound healing. Other pharmacological interventions, including 'antihyperalgesic' drugs such as NMDA-receptor antagonists and gabapentin, may interfere with the induction and maintenance of sensitization. Future studies will investigate the analgesic effect of prolonged multimodal combinations of different classes of 'traditional' analgesics and 'antihyperalgesics' on postoperative pain.
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Postponing childbearing beyond the teenage years is now adaptive practice for European Americans. European American adults put this cultural priority into action and employ substantial social resources to disseminate the social control message meant for their youth that teenage childbearing has disastrous consequences. ⋯ The entrenched cultural interdependence of and social inequality between European and African Americans lead African Americans to be highly visible and vulnerable targets of moral condemnation for their fertility behaviour. This, in turn, sets up African Americans to pay a particularly high price politically, psychosocially, and in terms of their health.