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Prostate pain is caused by the inflammation of the prostate gland, which is an exocrine gland of the male reproductive system. Its main function is to secrete and store a fluid that constitutes up to one-third of the volume of semen. This inflammation of the prostate is also known as prostatitis. If the prostate grows too large, it may constrict the urethra and impede the flow of urine, making urination extremely difficult and painful and in extreme cases, completely impossible. Prostatitis is usually treated with antibiotics, prostate massage or in extreme cases, surgery.

In older men, the prostate gland often enlarges to the point where urination becomes very difficult. This is known as benign prostatic hyperplasia and can be treated with medication or with surgery that removes a part of the prostate gland. The surgery technique most often used in such cases is called transurethral resection of the prostate. In this case, an instrument is inserted through the urethra to remove excess prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine.

Prostate cancer is one of the most common cancers affecting elderly men in developed countries and a major cause of death among them. Regular rectal exams are recommended for elderly men to detect prostate cancer in its early stages. There is also a blood test that measures the concentration of a protein, Prostate Specific Antigen (PSA), which is normally very low.

Elevated and more sophisticated test results may be an indicator of disorder within the prostate either prostatitis or benign hyperplasia or prostate cancer. The PSA test cannot distinguish between them, but can certainly lead a doctor to investigate further. Prostate cancer is treated with hormone manipulation, which is the prevention of production of testosterone, with radiation and surgery. It has recently been found that a drug known as Docetaxel can be effective in the treatment of prostate cancer.

Pain Medications

Pain medications generally deal with painkillers, medically known as analgesics. They are a member of the diverse group of drugs used to relieve pain. The word analgesic is derived from the Greek word ‘an’ which means ‘without’, and ‘algia’ which means ‘pain.’

Analgesic drugs act in different ways on the peripheral and central nervous system of the body. They include paracetamol (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, narcotic drugs such as morphine, synthetic drugs with narcotic properties such as tramadol, and various others. Some other classes of drugs, not otherwise considered analgesics, are also used to treat neuropathic pain syndromes, which include tricyclic antidepressants and anticonvulsants.

Analgesics can be broadly categorised into three groups. The first one comprises of Paracetamol and NSAIDs. The exact mechanism for action of paracetamol is uncertain, but it apparently acts centrally. Aspirin and the NSAIDs inhibit cyclo-oxygenase, leading to a decrease in prostaglandin production. This improves pain and also inflammation, in contrast to paracetamol and the opioids. Paracetamol has few side effects, but dosing is limited by possible hepatotoxicity (potential for liver damage). NSAIDs may predispose to peptic ulcers, renal failure, allergic reactions, and hearing loss, and may also increase the risk of hemorrhage.

The second group is of Opiates and morphinomimetics. Tramadol and buprenorphine are considered to be partial agonists of the opioid receptors. Morphine, the common opioid, and various other substances like pethidine, oxycodone, hydrocodone and diamorphine, all exert a similar influence on the cerebral opioid system. Dosing may be limited by toxicity caused by opoids leading to confusion, myoclonic jerks and pinpoint pupils, but there is no dose ceiling in patients who can tolerate this. Opioids, though very effective analgesics, may have some unpleasant side-effects. Up to 1 in 3 patients starting morphine, may experience nausea and vomiting, which is generally relieved by a short course of antiemetics. Pruritus or itching may require switching to a different opioid. Constipation occurs in almost all patients on opioids, and laxatives such as lactulose, macrogol-containing or co-danthramer are typically co-prescribed. When used appropriately, opioids and other similar narcotic analgesics are safe and effective, carrying relatively little risk of addiction. Occasionally, gradual reduction of the dose is required to avoid withdrawal symptoms.

The third category is of the specific agents consumed by patients suffering from chronic or neuropathic pain. Tricyclic antidepressants, especially amitriptyline, have been shown to improve pain in apparently a central manner. The exact mechanism of carbamazepine, gabapentin and pregabalin is unclear as well, but these anticonvulsants are used to treat neuropathic pain with modest success.

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