A Preemptive Strike Against Pain

Recovering from surgery can be less of a trial if patients' nerves are numbed right before surgery begins. A clinical study reported in tomorrow's issue of the Journal of the American Medical Association shows that blocking potential pain impulses to the spinal cord before making a surgical incision instead of waiting until the procedure is finished results in less pain and a quicker recovery.

Most doctors now provide pain relief to their patients after surgery, by numbing nerve receptors. However, research on lab animals has shown that traumatic experiences can rewire the nervous system to give a lingering painful feeling long after the stimulus is taken away. If nerves never sense the stimulus in the first place, the pain response won't get hardwired--and new pain signals can be blocked.

To see if this works in people too, a team led by Allan Gottschalk and David Smith at the University of Pennsylvania Medical Center in Philadelphia followed 100 patients whose prostate glands were removed. They injected 66 subjects before surgery with an anesthetic or narcotic that prevented signals from reaching the spinal cord. During the hospital stay, these patients reported feeling pain that was 33% less intense than those who had not received the treatment. What's more, 87% of these patients reported feeling no pain when surveyed 9.5 weeks after surgery, compared to only 47% of those treated the conventional way.

The procedure may not become common in the operating room unless the benefits are shown to outweigh complications seen in the study, such as fluctuating blood pressure during surgery, says Smith. However, the study's implications are much broader than preventing post-surgical pain, notes Daniel Carr, professor of pain management at the New England Medical Center in Boston. For example, giving a child a local anesthetic before drawing blood could not only numb the needleprick, but also might lessen long-term emotional or physical sensitivity to the needleprick.

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