Pain Management in Radiologic Procedures: A Clinical Review

Introduction

This paper identifies and explores the concept of pain management during radiologic procedures such as biopsies, angioplasties, and angiograms. The attributes of this concept are described, a literature review pertaining to the subject is presented, and the concept is applied to future clinical habits and practice. The value of these concepts and their associated traits are discussed in conclusion.

Reasons for Interest

The use of radiologic procedures to prevent, treat, and detect disease is invaluable in the current medical sphere. A biopsy performed to verify whether a patient has cancer, for example, is a delicate and critically important procedure. However, one major drawback of such procedures is the pain and mental anguish that patients experience before, during, and after them. Some patients will delay or refuse procedures outright, even when those procedures could save their lives or provide meaningful peace of mind. Accordingly, doing everything possible to manage and minimize pain — so as to achieve the needed results and treat patients' medical conditions — is essential to extending and improving their quality of life.

Traits and Relevant Uses

There are two main dimensions to pain management during radiologic procedures, and they must be balanced together. The quality of care and the efficacy of applicable detection methods must be weighed against the patient's pain level. Some pain during radiologic procedures is unavoidable; even a sedated patient may experience discomfort after waking. However, avoiding patient discomfort at the expense of quality of care or reliable results is never acceptable. Patients must be made aware of the importance of the procedure they are undergoing and should be given full, honest information about what they can reasonably expect to feel. That said, all reasonable efforts to eliminate or at least mitigate pain — accompanied by compassionate communication — represent the right course of action on every level.

A substantial body of scholarly literature exists on pain management surrounding radiologic procedures. The first study reviewed was published in 2007 and pertains to pain related to slow or absent drainage in the pancreatic duct and how to address it. Surgical drainage was found to be significantly more effective than endoscopic drainage for patients with chronic pancreatitis. This finding is relevant to the concept discussed here because many associated procedures involve the use of stents (Chennat & Waxman, 2007). A study on much the same topic, published in an endoscopy journal in 2006, notes that stents are used specifically to relieve pain in some cases. For that reason, the pain associated with the placement and maintenance of a stent should be factored into an analysis of how much less pain will be present once the stent is properly in place (Katanuma et al., 2006).

Literature Review

Other research demonstrates that not all pain management techniques involve medication. A study published in 2006 found that the use of music with patients undergoing certain procedures — including C-clamp coronary procedures and other radiologic interventions — had a meaningful role in soothing and calming patients who were agitated or anxious (Chan et al., 2006). Similarly, a pediatric study from 2005 found that hypnosis applied to children undergoing invasive procedures, including biopsies, produced comparable positive effects in reducing distress and procedure duration (Butler et al., 2005).

Another study noted that not all pain and discomfort fits neatly into conventional categories. A useful example is the after-effects of prostate biopsies on everyday activities such as sexual function. The study notes that prostate screenings can adversely affect sexual health and performance. A multimodal approach is described as beneficial, though the authors acknowledge that any approach carries both obvious and less obvious drawbacks (Aktoz et al., 2010).

Two additional articles reviewed for this paper address the way radiologic procedures, though they can themselves cause pain, are also used to identify the real sources of pain. One study from 2003 noted that radiologic imaging can be used to analyze cartilage and ligaments in the knee. While having one's knee scoped can be uncomfortable, the knowledge gained can benefit the patient substantially in the long run (Jackson, O'Malley & Kroenke, 2003).

A related study examined the use of radiologic techniques in diagnosing lumbar back issues. Back pain is often severe and seemingly unrelenting, but radiologic methods can definitively identify its causes, including pinched nerves and disc herniation. The study looked specifically at changes in pain levels after percutaneous endoscopic lumbar discectomy and annuloplasty for lumbar disc herniation. Results showed that the vast majority of patients experienced improvement, with many achieving complete pain relief. Pain improvement rates clustered in the 80–90% range. No patients reported zero change — all reported either improvement or regression (Choi, Kim, Kang, Lee & Lee, 2011).

The final study reviewed pertains to pain management interventions during bone marrow biopsy. While this procedure is highly invasive and painful, it remains the most effective method for detecting hematological disorders, and patients who test positive must undergo repeated biopsies over time. The aspiration and core sampling involved can be excruciating and profoundly stressful. The study identifies three primary pharmacological methods that stand out above all others for managing this pain: intravenous midazolam, pre-medication with analgesia and/or anxiolytic agents, and the use of Entonox — the brand name for nitrous oxide (Watmough & Flynn, 2011).