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22 July 2008
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Anesthetic gel reduces breast mammogram pain
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MedWire News: The application of topical lidocaine gel can reduce breast discomfort during mammography exams for women who fear the procedure, results of a clinical trial suggest.
"This simple intervention could be offered to these women to improve the mammography experience and break the cycle of anxiety and fear that leads to delays and avoidance of this potentially lifesaving procedure," lead researcher Colleen Lambertz (St Luke's Mountain States Tumor Institute, Boise, Idaho, USA) and colleagues comment.
Randomized trials have shown that early detection of breast cancer with mammography reduces breast cancer mortality in women aged 40-70 years by up to 50%.
Yet recent reports suggest that approximately 50-66% of women do not follow established guidelines for mammography.
One factor underlying this nonadherence is the fear of pain. It is well documented that many women experience discomfort during mammography and that expectation of pain and anxiety are predictors of actual pain with the procedure.
A recent study serendipitously found that almost a quarter of women studied took oral pain medication before their mammogram, yet there have been very few dedicated studies investigating prophylactic pain relief.
In the present study, the researchers initially performed telephone interviews assessing expected discomfort of mammography on a scale of 0-100 among women scheduled to undergo the procedure.
The researchers then selected 418 women who expected the level of discomfort to be 40 or higher and randomized them to receive various combinations of acetaminophen (1000 mg), ibuprofen (800 mg), 4% lidocaine gel, and oral and gel placebos before undergoing the procedure.
As reported in the journal Radiology, scores for discomfort during mammography ranged from 0-100 and averaged 39.8. Detailed analysis revealed that 4% lidocaine gel was the only treatment that significantly reduced discomfort, with discomfort score in the lidocaine-only group averaging 32.7.
Lambertz et al note that Lidocaine gel is a readily available, over-the-counter anesthetic that is easy to apply and remove. They add that in the study the gel was applied by the attending nurse, however, women could apply the gel at home one hour prior to appointment time and remove it immediately before undergoing the exam.
Radiology 2008; Advance online publication
http://radiology.rsnajnls.org/
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