Lidocaine Reduces Pain Prostate Biopsy
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How Much Does it Hurt Just to Read About the Following Cases? A woman nearly faints as a physician snips tissue from the lining of her uterus—with no pain medication. A man whimpers as he endures, without drugs, a procedure to take a sample of his prostate gland through his rectum. An elderly man with early Alzheimer's has a sigmoidoscope fed into his colon and several polyps clipped off with no palliative. Unfortunately, these are not scenes from 19th-century medicine. Nor are they departures from generally approved medical practice. Their equivalent occurs thousands of times every day in the U.S. alone. Word seems to have gotten out that doctors should more aggressively treat severe, long-lasting pain resulting from cancer, chronic syndromes, surgery or terminal illness. After years of public information campaigns, changes in medical school curricula, and educational efforts by physicians' organizations, hospitals are finally updating their practices. Physicians are increasingly encouraged to view pain as the "fifth vital sign," along with pulse, respiration, temperature and blood pressure; in 2001 the Joint Commission on Accreditation of Healthcare Organizations issued guidelines for treating pain in patients with both terminal and nonterminal illnesses. But the guidelines do not specifically address invasive tests or outpatient surgeries such as those cited above, and many medical practitioners still expect people to keep a stiff upper lip about the pain involved in such procedures. This despite the fact that the tests often already humiliate and frighten patients. Dermatologists routinely deliver lidocaine when removing moles and such growths from the skin. More and more physicians are offering light anesthesia for colonoscopies. But palliative care must be made universal for people undergoing cancer-screening procedures if physicians want their patients not to avoid the tests. Why is pain relief not routine in these situations? A major factor is a lack of knowledge. Only recently have researchers shown that lidocaine injections or nitrous oxide (laughing gas) can significantly reduce pain during a prostate biopsy. Lidocaine has not been as successful against the pain of a biopsy of the uterine lining, but a mere handful of studies have been performed, most of them outside the United States. Richard Payne, chief of pain and palliative care at Memorial Sloan-Kettering Cancer Center in New York City, attributes the paucity of U.S. research in this field in part to lack of interest among doctors. Another reason is risk. Pain-killing drugs and sedatives can have strong effects—in rare cases, life-threatening ones. Monitoring patients to prevent bad outcomes can be costly. Administering a pain reliever or sedative during outpatient surgery could require physicians' offices to have a recovery area where patients could be monitored for side effects until they are alert and comfortable enough to leave. Such a recovery room—and the nursing staff to monitor those in it—would raise costs. The least forgivable excuse for not alleviating pain would be for medical culture (and maybe society at large) simply to believe that pain ought to be part of medicine and must be endured. Weighing the risks and benefits of pain control should ultimately be the province of the patient. If doctors say there is no pain control for a given procedure, patients should ask why not. People undergoing invasive tests should at least be offered options for pain relief—even if they decide after all to bite the bullet.
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