HUP researchers ease prostate pain

As many older men can attest, having a prostatectomy is no joy ride. The surgery, performed on many prostate cancer patients, involves complete removal of the prostate gland. But thanks to a recent study by doctors at the Hospital of the University of Pennsylvania, prostatectomies are becoming less excruciating ordeals. Allan Gottschalk of HUP's Anesthesia Department worked with colleagues for six years to test preemptive analgesia, the practice of treating surgery-related pain before the actual surgery. This method dramatically reduces post-operative agony that often lingers for weeks after a major operation, researchers say. Gottschalk's study on the effects of preemptive analgesia on prostate-surgery patients was published in the April 8 issue of the Journal of the American Medical Association. "We're talking about severe pain," explained Gottschalk. By giving patients preemptive analgesia, "it lowers the pain level while they're in the hospital and later on when they return home." Gottschalk noted that of the 23 million operative procedures performed annually in the United States, 12 million patients experiencing pain were inadequately treated. Through this study, Gottschalk's team "showed that apart from a 33 percent reduction in pain, patients were more active 3 1/2 weeks after the operation, and more than twice as likely to say they were pain-free 9 1/2 weeks after the operation," he said. And preemptive analgesia can be used for much more than just prostatectomies. "I use this approach any time I do a major procedure below the neck," said Gottschalk. The actual process of preemptive analgesia involves an injection consisting of local anesthetics and opiates, of which morphine is the most common. The drugs are sent through an epidural catheter, "a thin plastic tube inserted into the patient's back and threaded into the space just outside the spinal cord," according to Gottschalk. "We basically turn off the lower part of the body," he said. The drugs then stop the transmission of pain signals through nerves to the spinal cord, halting the sensitization that occurs and thereby stopping pain before it starts. Philadelphia resident Alfred Little had a prostatectomy at HUP in February and was administered preemptive analgesia. Little recalled that after waking up from anesthesia, he was asked to rate his pain on a scale of one to 10. He told his nurse it was a two. "The procedure had been done to deaden all of the nerves before the operation actually took place," said Little. Consequently, "as you start to recover, there's less to recover from in terms of pain." Gottschalk said he hopes to use the results to get a grant from the National Institutes of Health for a larger-scale study.