Most patients undergoing image-guided biopsies don't feel any pain

A majority of patients don’t experience any pain during image-guided percutaneous biopsies, according to a new study published in the American Journal of Roentgenology. But researchers did find that certain groups report pain more often than others.

“Appropriately managing pain and anxiety has a direct impact on safely and successfully performing percutaneous image-guided procedures,” wrote Veena R. Iyer, MD, department of radiology at Mayo Clinic in Rochester, Minnesota, and colleagues. “Radiologists are increasingly involved in direct patient interaction and patient care. Understanding the prevalence and predictors of procedure-related pain can help referring clinicians and radiologists appropriately counsel patients before their procedure and can help proceduralists know when to anticipate and therefore more effectively manage pain.”

Iyer et al. explored data from more than 13,000 biopsies performed on more than 10,000 patients at a single institution from July 22, 2013, to Feb. 1, 2018. All patients were at least 18 years old, and any patients who had a vertebral biopsy or more than one biopsy on the same day were excluded. A majority—58.6%—of the patients were men, and the median age at biopsy was 61 years old. In addition, 56.7% of biopsies were performed without sedation.

Patients were asked to rate any pain they experienced on a scale of one to ten. If there was no pain at all, they reported a zero for “no pain.”

Overall, 26.8% of patients reported experiencing pain. A pain score from one to three was reported by 13.6% of patients; a score from four to six was reported by 9.1% of patients; and a score of seven or higher was reported by 4.1% of patients. An adjusted model found associations between experiencing pain and female patients, younger patients, patients who underwent IV sedation and an increasing needle diameter.

“Compared with those undergoing biopsies in allograft kidneys, patients with biopsies in all other locations except liver allografts were significantly more likely to report experiencing pain,” the authors added.

Diving deeper into the data, the team found that biopsies were “completely pain free” for 83.1% of kidney allografts, 79.2% of renal lesions, 79.1% of liver allografts, 77% of native kidneys, 76.8% of lung masses, 69.7% of native livers and 64.1% of liver lesions. For all other biopsies, 67.5% were pain free.

“In this era of quality measurement in interventional radiology, our results showing that patients report no pain with most image-guided biopsies serve as an important benchmark,” the authors concluded. “This information can be used for pre-procedural patient education to reassure patients who fear the unknown. It can inform practices or proceduralists new to image-guided biopsy procedures of the expected patient outcomes. Knowing that younger patients report greater pain can drive future efforts to assuage anxiety in these patients and possibly improve their experience.”