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Pain Ratings by Patients and Their Providers of Radionucleotide Injection for Breast Cancer Lymphatic Mapping.
MedLine Citation:
PMID:  22536858     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background.  Disparity between patient report and physician perception of pain from radiotracer injection for sentinel node biopsy is thought to center on the severity of the intervention, ethnic composition of population queried, and socioeconomic factors. Objective.  The objectives of this study were, first, to explore agreement between physicians' and their breast cancer patients' pain assessment during subareolar radionucleotide injection; and second, to evaluate potential ethnic differences in ratings. Methods.  A trial was conducted, from January 2006 to April 2009, where 140 breast cancer patients were randomly assigned to standard topical lidocaine-4% cream and 99mTc-sulfur colloid injection, or to one of three other groups: placebo cream and 99mTc-sulfur colloid injection containing NaHCO3, 1% lidocaine, or NaHCO3 + 1% lidocaine. Providers and patients completed numeric pain scales (0-10) immediately after injection. Results.  Patients and providers rated pain similarly over the entire cohort (median, 3 vs 2, P = 0.15). Patients rated pain statistically significantly higher than physicians in the standard (6 vs 5, P = 0.045) and placebo + NaHCO3 (5 vs 4, P = 0.032) groups. No significant difference in scores existed between all African Americans and their physicians (3 vs 4, P = 0.27). Conclusion.  Patient-physician pain assessment congruence over the less painful injections and their statistically similar scores with the more painful methods suggests the importance of utilizing the least painful method possible. Providers tended to underestimate patients with the highest pain ratings-those in the greatest analgesic need. Lack of statistical difference between African American and physician scores may reflect the equal-access-to-care over the entire patient cohort, supporting the conclusion that socioeconomic factors may lie at the heart of previously reported discrepancies.
Authors:
Jason S Radowsky; Lyndsay Baines; Robin S Howard; Craig D Shriver; Chester C Buckenmaier Iii; Alexander Stojadinovic
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-26
Journal Detail:
Title:  Pain medicine (Malden, Mass.)     Volume:  -     ISSN:  1526-4637     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100894201     Medline TA:  Pain Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Wiley Periodicals, Inc.
Affiliation:
Department of Surgery Department of Clinical Investigation, Division of Biostatistics Clinical Breast Care Project Defense and Veterans Pain Management Initiative, Anesthesia and Operative Service, Walter Reed Army Medical Center, Washington, D.C. Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland United States Military Cancer Institute, Clinical Trials Group, Washington, D.C., USA.
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