BACKGROUND The predictable relationship between surgical injury responses and the ensuring postoperative pain has led to the development of the concept of preemptive analgesia, with its potential to improve the quality of the postoperative period. METHODS A review of publications concerning the studies of the physiology of pain and the development of clinical strategies toward the prevention of postoperative pain was undertaken. RESULTS Clinical studies using various methodologies indicate that preemptive analgesia may, in some circumstances, attenuate postoperative pain. Unfortunately, these studies were not always reproducible. Preemptive analgesia in these studies failed to prevent or attenuate postoperative pain. CONCLUSIONS Techniques directed toward reducing and/or eliminating postoperative pain are still being developed, and their clinical utility is yet to be fully evaluated.