Pre-Mammography Painkiller May Ease the Pinch

BOISE, Idaho, July 22 (MedPage Today) -- Numbing the breasts with lidocaine gel may make mammography less uncomfortable, and may help assure regular screening, researchers found.

In a placebo-controlled trial, women who used over-the-counter lidocaine (Topicaine) before mammography reported less discomfort (P=0.01) than those taking acetaminophen, ibuprofen, or placebo, reported Colleen K. Lambertz, M.S.N., F.N.P., of the St. Luke's Mountain States Tumor Institute here, and colleagues, online in Radiology.

Those who took acetaminophen and ibuprofen to ease pain felt no relief, the researchers said.

Women who reported less discomfort were more satisfied and more likely to plan to come back for a mammography the following year (P<0.001), the researchers said, although the gel did not appear to be directly responsible (P=0.49).

"This simple intervention could be offered to women to improve the mammography experience and break the cycle of anxiety and fear that leads to delays and avoidance of this potentially lifesaving procedure," the investigators said.

At least half of American women do not get a mammography as often as recommended, they noted.

The study included 418 women scheduled to undergo screening mammography over a two-month period in 2006. All had said they expected discomfort of at least 40 on a 100-point scale when asked by telephone before their appointment.

Notably, more than 70% of the much larger group of women screened for participation in the study expected the same degree of uncomfortableness.

"The expected discomfort scores indicate that the general belief in this motivated population of women was that undergoing mammography hurts," the researchers noted.

Although all these women scheduled mammography despite their expectations, they added, "we do not know, however, how many women do not schedule mammography at all because of this same concern."

Study participants were randomly assigned to double-blind routine mammographic screening or to treatment before mammography with 1,000 mg of acetaminophen, 800 mg of ibuprofen, oral placebo, 1 ounce or less of 4% lidocaine gel, gel placebo, or combinations thereof.

The gels were applied over the breasts and chest wall by a nurse and wiped off before mammography for a total absorption time averaging 48 minutes. Oral medications were given a median 80 minutes before mammography.

Overall, 42.3% of the women reported discomfort scores greater than 40 during mammography. This was typically related to the tightness of squeezing (70.4%), pulling on the skin (31%), and edges poking into the body (37.5%).

Among all the combinations of analgesics used, lidocaine gel consistently was associated with the lowest discomfort scores during mammography.

On the 100-point visual analogue scale, lidocaine was associated with significantly lower scores than both placebo gel and usual care alone (adjusted mean 32.7 versus 37.7 and 36.0, P=0.01).

After adjustment for expected discomfort, age, breast density, and history of previous screening mammography, and for the combination of technologist and mammography machine used, there were no significant differences between types of oral medication and oral placebo (P=0.35).

Nor were there any interactions between the type of gel and oral medication (P=0.84).

Satisfaction with the procedure, however, was more influenced by interactions with staff and history of breast cancer. The significant factors included:

• Discomfort significantly decreased satisfaction (P<0.001)
• A personal history of breast cancer increased satisfaction (P=0.05)
• A nurse or technologist who listened and made adjustments as requested increased satisfaction (both P<0.001)
• A technologist who explained the procedure in understandable terms increased satisfaction (P<0.001)
• A technologist who the patient felt cared about them personally increased satisfaction (P<0.001)

The type of gel made no difference in satisfaction scores (P=0.55) after adjustment for discomfort, breast cancer history, the nurses' responsiveness to patient requests, and the combination of technician and mammography machine.

Nor was there an effect of the type of oral medication (P=0.25) or the combination of gel and pill (P=0.84).

Women who rated their satisfaction with the procedure lower were more likely to have delayed having a mammogram (P=0.004).

Plans to undergo mammography the next year were not directly affected b gel type (P=0.49), oral medication (P=0.32), or interaction between the two (P=0.25) after adjustment for perceived discomfort, satisfaction, and expectation-related mammography delay.

However, mammography plans were related to satisfaction with the procedure (P<0.001) but not actual discomfort during mammography (P=0.40).

In addition to few side effects and no substantial adverse reactions, the researchers said, the lidocaine gel was easily accessible over-the-counter and easy to apply and remove.

Whereas the gel was applied by a nurse in the study for the sake of consistency, application at home an hour before a mammography appointment would likely be more convenient with little to no cost to the mammography facility, they said.

The authors noted that the study was limited by inclusion of only women who expected greater discomfort.

The study was supported by the Mountain States Tumor Medical Research Institute grant. The brand-name lidocaine gel was provided by ESBA Laboratories at no charge to the researchers for use in the study.

The researchers reported no financial conflicts.

Primary source: Radiology Source reference: Lambertz CK, et al "Premedication to reduce discomfort during screening mammography" Radiology 2008; 248: DOI: 2482071490.

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