By virtue of their nature involving extensive dissection of muscles, ligaments and bones, spinal surgeries inherently produces high severity of postoperative pain. Additionally, the patients subjected to spinal surgeries may have suffered a significant degree of preexisting “chronic pain” treated previously with high doses of narcotics or other analgesics necessitating massive doses in the postoperative period. Thus postoperative pain management following spinal surgeries becomes a complicated issue for the treating anaesthesiologist in the face of these concerns and multi modal analgesia is often necessary to obtain adequate relief from pain. Mechanoreceptors or nociceptors present in the different tissues (vertebrae, disc, ligaments, nerve root sleeves) elicit the pain sensation which is carried by posterior rami of spinal nerves linked to sympathetic, parasympathetic, motor and somatic nerves. This widespread interconnectivity increases the possibility of referred pain which surpasses local and diffuse pain following surgery. VAS scores tends to be higher in patients with continuing referred pain. Neuropathic nature of referred pain makes it amenable to treatment with anticonvulsants and antidepressants. The site of spinal surgery (cervical, thoracic or lumbar) does not have any bearing on the severity of postoperative pain. However psychological profile, social profile and preoperative pain severity does influences the degree of post operative pain.

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