Radiologic Procedure Pain Management The author of this report is asked to identify and explore a given concept. The concept that shall be explored is pain management during procedures like biopsies, angioplasties and angiograms. This concept was selected by the author of this report because it is closely related to the interests and studies of the author. The attributes of the policy will be described by the author. The author has also done a literature view pertaining to the subject at hand and the author will also apply the concept to future habits and tactics that will be used when the author is practicing medicine. The value of these concepts and the associated traits will be enumerated to close out this report.

Reasons for Interest

The use of radiologic procedures to prevent, treat and detect disease is invaluable in the current medical sphere. Just as one example, doctors and nurses engaging in a biopsy to verify whether a patient has cancer or not is a very delicate and important procedure. However, one major detractor and side effect of doing such procedures is the pain and mental anguish that patients are subjected to before, during and after such procedures. Indeed, some patients will delay or simply not allow for such procedures even though it can literally save their life and/or give them peace of mind. As such, the author of this report is greatly interested in doing what is possible to manage and minimize pain so as to garner the needed results and/or treat the medical conditions in play for a patient and thus extending their life and/or making it more fruitful and stress/pain-free.

Traits & Relevant Uses

There are two main dimensions to pain management during radiologic procedures and they must be balanced together. The quality of care and efficacy of any applicable detection methods should be balanced with the pain level of the patient. Of course, some pain during radiologic procedures is not avoidable and even if the patient is sedated during the procedure, they still may encounter discomfort after they wake up. However, avoiding patient discomfort at the expense of quality of care and/or reliable results is a non-starter and should never be accepted. Patients have to be made aware of the importance of the procedure they are undergoing but should also be given full warning about what might reasonably occur from a feeling and pain standpoint. That being said, all reasonable efforts to eliminate or at least mitigate such pain as well as some soothing words along the way is the right move on so many levels.

Literature Review

There is a mountain of scholarly literature to be found pertaining to pain management surrounding radiologic procedures. The author of this report found research referencing several important dimensions of pain management related to radiologic procedures and methodologies to help manage the same. The first bit of research was published in 2007 and pertains to pain related to slow to non-existent drainage in the pancreatic duct and how to avoid it. It was found that surgical drainage was much more effective than endoscopic drainage for patients with chronic pancreatitis. This finding is relevant to the concept in this report because many of the associated procedures involve the use of stents (Chennat & Waxman, 2007). A study on much the same topic was published in an endoscopy journal in 2006, the year prior. They note that stents are used specifically to relieve pain in some instances. For that reason, the pain associated with the placement and maintenance of the stent should be included with the analysis of how much less pain will be present after the stent is properly placed (Katanuma et al., 2006).

In a different vein, other research found that not all pain management techniques involve the use of drugs. It was discovered per a study published in 2006 that the use of music with patients undergoing certain procedures including C-clamp coronary procedures (among other radiologic procedures) had a role in soothing and easing the patient if they were agitated or had an elevated mood of any sort (Chan et al., 2006). Similarly, a pediatric study in 2005 found that hypnosis on children that were being subject to any invasive procedure, including biopsies and such, had the same positive effects (Butler et al., 2005).

A different study noted that not all pain and discomfort is limited to what is commonly thought of or referred to when speaking on the subject. A good example of a common but perhaps not referenced enough example would be after-effects...

The study notes that prostate screenings can have an ill effect on sexual health and performance if not effectively stops sexual function in general. The study notes that multi-modal approach is a good one but also notes that are always drawbacks, obvious and not so obvious, despite the approach actually selected in the end (Aktoz et al., 2010).
The next two articles reviewed for this report pertain to radiologic procedures, despite themselves causing pain, can actually be used to decipher the real causes of pain and such uses like this are actually quite common. One example cited was found by the author of this report in a 2003 study that noted that radiologic screens can be used to analyze cartilage and ligaments in the knee. Sure, having one's knee scoped can be painful but the knowledge gained from such analysis can actually help the patient immeasurably more in the long run (Jackson, O'Malley & Kroenke, 2003).

The similar study to the one just mentioned related to similar scoping and researching of lumbar back issues. Back pain is indeed tortuous and seemingly everlasting to some people but radiologic techniques, as noted in the study, can be used to definitively diagnose what is causing pain including pinched nerves and herniation. The study that mentions this looks specifically at the overall change in pain levels after percutaneous endoscopic lumber discectomy and annuloplasty for lumbar disc herniation. The results bear out that a vast majority of patients found better results with pain if not a complete relieving of pain. However, some study recipients found a regression or aggravation in pain. The biggest plot points for relief, in terms of percentage, were in the center and at the 80 to 90% "better" range. Literally no patients reported no relief at all as all reported either an improvement or a regression (Choi, Kim, Kang, Lee & Lee, 2011).

The final study reviewed for this report pertains to pain management interventions with bone marrow biopsy patients. The study notes that while the procedure to screen bone marrow via biopsy is quite painful and invasive, it is also true that it is far and away the best way to detect hematological disorders. Indeed, patients that prove positive actually have to get the biopsies on a recurring basis. The aeration and core sampling involved with biopsies can be excruciating and stressful, no doubt. They note that with bone marrow biopsies, there are three main methods suggested that stand out above anything else. Those methods are all pharmacological and include intravenous midazolam, pre-medication with analgesia and/or anxiolytic metholdogy along with the use of Entonox. The latter substance is a brand name for nitrous oxide.

Theoretical & Operational Definitions

It is necessary to lay forth the theoretical and operational definitions relating to the literature review and to the concept in general. The definition of the radiologic procedures in question is not really an issue, but perhaps a longer list of procedures that would apply with this concept should be laid out. Procedures that the author of this report is really referring to would include biopsies, TIPS, cyroblations, insertion of utereal stents, angiograms, angioplasty, arthectomies and so forth. Common pain medications that are used parallel to such procedures are Versed and Fentanyl. The reason for the procedures listed varies a lot but the pain that can manifest through many of the procedures is very real. A biopsy is excision of tissue to determine if malignancy is present. A stent is often used to keep arteries from closing out and causing heart attack or stroke issues.

From a theoretical perspective, this can take on many forms. Pain can be stabbing bursts or it can be a dull (or even a very loud) "roar" that engulfs the patient either during or after a procedure. Mental anguish is very real as well. It is not unlike kids who loathe going to get shots or getting blood drawn but facing one's mortality can be paralyzing and gut-wrenching to patients. From an operational standpoint, there is much more logic and reason and less emotion. If a biopsy is being ordered, there is a very good reason for it. In addition, it is also known as a matter of science what can go wrong and what pain is usually induced while a biopsy or other radiologic procedure is under way. There are associated pain management methods and doses that can and should be administered based on the feedback and preferences of the…