Pain levels of patients undergoing ultrasound guided biopsies and associated factors: a cross-sectional study

Abstract

Aim: Patients may experience pain in minimally invasive biopsy procedures. It is important to evaluate the degree of pain and to know the factors that determine the level of pain felt by patients for adequate pain management. The aim of this study is to determine the pain levels felt by patients and socio-demographic and clinical factors associated with higher pain levels in breast and liver biopsy procedures. Material and Method: In this cross-sectional observational study, patients who will undergo ultrasound-guided breast and liver biopsy procedures in the study center were invited to the study. The pain level was measured with the Visual Analogue Scale (VAS). Pain measurements above 45mm were classified as moderate-to-high pain levels. The State-Trait Anxiety Scale was used to measure the anxiety levels of the patients and the radiologist. Sociodemographical (sex, age, education level, job, income) and clinical factors (biopsy site, duration, bosy mass index, anxiety level of the patient and the radiologist) that may be associated with the pain levels of the patients were analyzed. Results: The sample consisted of 76 patients, 62 were female (81.6%). The procedures consisted of 43 breast biopsies (56.6%), 33 liver biopsies (43.4%). The median pain level measurement determined by the VAS is 20.0mm (IQR: 9.3- 38.5). Most of the sample (59.2%) stated that they felt mild pain. It was found that patients with higher anxiety levels and patients underwent liver biopsy had statistically significantly higher moderate-to-high pain levels than patients with lower anxiety (OR: 3.683 95% CI: 1.159- 11.705, p=0.220), patients who underwent breast biopsies (OR: 3.521, 95% CI: 1.153- 10.752, p=0.023). A positive correlation was found between the level of pain and the level of anxiety (r=0.267, p=0.020). Conclusion: This study demonstrated that most ultrasound-guided biopsy procedures were performed with mild or no pain although higher patient anxiety levels were associated with higher pain levels during the procedures. Patients undergoing liver biopsy procedures had higher pain levels than breast biopsy procedures.

Keywords

• ultrasonography
• biopsy
• pain
• breast
• liver

References

1. Bick U, Trimboli RM, Athanasiou A, et al. Image-guided breast biopsy and localization: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imag 2020; 11: 12.
2. American College of Radiology. ACR practice parameter for the performance of ultrasound-guided percutaneous breast interventional procedures. Available at: https: //www.acr.org/-/media/ACR/Files/Practice-Parameters/US-GuidedBreast.pdf. 01.12.2021
3. Bedossa P, Patel K. Biopsy and noninvasive methods to assess progression of nonalcoholic fatty liver disease. Gastroenterology 2016; 150: 1811-22.e4.
4. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Andrew K. Clinical management 4 of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. 5 European Association for the Study of the Liver. J Hepatol 2001; 35: 421-30.
5. Flory N, Lang EV. Distress in the radiology waiting room. Radiology 2011; 260: 166-73.
6. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993; 118: 96-8.
7. Soo AE, Shelby RA, Miller LS, et al. Predictors of pain experienced by women during percutaneous imaging-guided breast biopsies. J Am Coll Radiol 2014; 11: 709-16.
8. Eisenberg E, Konopniki M, Veitsman E, Kramskay R, Gaitini D, Baruch Y. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg 2003; 96: 1392-6.

9. Tan KT, Rajan DK, Kachura JR, Hayeems E, Simons ME, Ho CS. Pain after percutaneous liver biopsy for diffuse hepatic disease: A randomized trial comparing subcostal and intercostal approaches. J Vasc Intervent Radiol 2005; 16: 1215-9.
10. Tekdogan U, Tuncel A, Nalcacioglu V, Kisa C, Aslan Y, Atan A. Is the pain level of patients affected by anxiety during transrectal prostate needle biopsy? Scand J Urol Nephrol 2008; 42: 24-8.
11. Drage N, Greenall C, Farnell DJ. Ultrasound-guided fine-needle aspiration cytology of lesions in the head and neck performed without local anaesthesia: an analysis of pain perception. Ultrasound 2018; 26: 222-8.
12. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17: 45-56.
13. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain 2016; 13: 67-75.
14. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003; 4: 407-14.
15. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jakobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto CA: Consulting Psychologists Press Inc, 1983.
16. Ozguven IE. Stress and anxiety scales and sociometric, psychologic tests (in Turkish). Ankara: Yeni Dogus Matbaası, 1994: 321-324.
17. Haun M, Mainous RO, Looney SW. Effect of music on anxiety of women awaiting breast biopsy. Behav Med 2001; 27: 127-32.
18. Bugbee ME, Wellisch DK, Arnott IM, et al. Breast core-needle biopsy: clinical trial of relaxation technique versus medication versus no intervention for anxiety reduction. Radiology 2005; 234: 73-8.
19. Soo MS, Jarosz JA, Wren AA, et al. Imaging-guided core-needle breast biopsy: Impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol 2016; 13: 526-34.
20. Çakir Ö, Aksu C. Subcapsular local anesthesia approach in percutaneous liver biopsy: less pain, more comfort. Turk J Med Sci 2021; 51: 342-7.
21. Zografos GC, Zagouri F, Sergentanis TN, Nonni A, Lymperopoulos N, Patsouris E. What parameters affect pain in core biopsy? Eur Radiol 2008; 18: 1144-5
22. Satchithananda K, Fernando RA, Ralleigh G, et al. An audit of pain/discomfort experienced during image-guided breast biopsy procedures. Breast J 2005; 11: 398-402.
23. Dotan Y, Carlebach M, Zuckerman E, Maruf M, Schiff E. Delayed bleeding after percutaneous liver biopsy. Eur J Case Rep Intern Med 2016; 3: 000359.
24. Sanansilp V, Dejarkom S, Deetayart S. Postoperative pain management and the risk factors in major operation: a baseline study of acute pain service, Siriraj Hospital. J Med Assoc Thai 2016; 99: 549-56.
25. Kumar M, Kumar J, Saxena I. The role of mental distraction on the pain response in healthy young Indian adults. J Clin Diagn Res 2012; 6: 1648-52.
26. Zeidan F, Gordon NS, Merchant J, Goolkasian P. The effects of brief mindfulness meditation training on experimentally induced pain. J Pain 2010; 11: 199-209.