Predicting pain: Anxious patients reported higher levels of breast biopsy discomfort

The vast majority of women experience only mild discomfort during image-guided breast biopsy, but some, namely younger women and those anticipating stonger pain to begin with, are more likely to experience greater levels of pain during the procedure, according to a study published in the July issue of the Journal of the American College of Radiology.

“Awareness of these findings may help radiologists better manage patients' pain during procedures,” wrote Adrianne E. Soo, researcher from the University of North Carolina School of Medicine in Chapel Hill, and colleagues.

To better evaluate pain experienced by women during core-needle breast biopsy, Soo and colleagues recruited 136 women undergoing stereotactically or ultrasound-guided biopsy or cyst aspiration. These patients were given a questionnaire that assessed pre-procedure factors such as anticipated biopsy pain and ongoing breast pain, and they were then also asked about pain experienced during the actual procedure.

Nearly 40 percent of the women reported no pain, and 48.5 percent reported mild pain (1-3 on a 10-point scale), according to the authors. Moderate to severe pain (4 to 10) was reported by 11.8 percent.

“Low levels of pain reported during biopsy support the efficacy of locally administered anesthesia, which should be standard care for any percutaneous breast biopsy procedure and may have even temporarily alleviated prebiopsy breast pain in some cases,” wrote Soo and colleagues.

Results showed younger age and higher anticipated biopsy pain were significant predictors of greater biopsy pain, as was greater prebiospsy breast pain.

Women undergoing stereotactic procedures and those undergoing procedures with lower needle gauge—meaning a larger needle—also reported greater pain.

Tumor size, histology, menopausal status, the experience level of the radiologists and the number of radiologists performing the biopsy were all not associated with pain levels.

Given that anticipated level of pain was the factor most strongly associated with biopsy pain, the authors underscored the importance of communication with patients before the procedure to share coping strategies that might reduce anxiety.

“Providing patients with education about common pain levels, sensations they might experience during biopsy, and strategies to reduce pain may improve the biopsy experience,” wrote Soo and colleagues.