NEW YORK—Pain
treatment before surgery can minimize pain after surgery, may reduce anesthetic
need during the procedure, and could minimize the risk of chronic pain
conditions developing in the long-term, according to pain expert Mark J. Lema,
MD, PhD.

"No one having surgery in America should suffer from
distressing pain after a procedure—it’s that simple," said Dr. Lema,
chairman of the Department of Anesthesiology and Pain Medicine, Roswell Park
Cancer Institute, Buffalo. "This does not mean pain wouldn’t occur after
surgery, but that distressing, suffering components to the pain should be
adequately addressed."

Dr. Lema spoke at an American Medical Association media
briefing on pain management, sponsored by an unrestricted educational grant
from Purdue Pharma, L.P.

He described two recent randomized studies showing the value
of preoperatively initiated thoracic epidural analgesia in reducing long-term
post-thoracotomy pain and of preemptive nonsteroidal anti-inflammatory drugs (NSAIDs)
in reducing pain after ambulatory arthroscopic knee surgery. Both studies can
be found in the January 2002 issue of Anesthesia & Analgesia.

In addition, Dr. Lema said that his group has had
"great success" administering COX-2 inhibitors an hour prior to colon
resection surgery performed under nonopioid general anesthesia with an epidural
catheter delivering an opioid analgesic; these patients required minimal
postoperative pain control.

Post-Thoracotomy Pain

In the study of post-thoracotomy pain, from the University
of Istanbul, Turkey, 69 patients were randomized to one of three arms: thoracic
epidural analgesia (a bupivacaine and morphine solution) initiated
preoperatively, that same solution initiated postoperatively, or IV
patient-controlled analgesia (PCA) with morphine postoperatively.