title: Pain ratings by patients and their providers of radionucleotide injection for breast cancer lymphatic mapping.
abstract: BACKGROUND
  Disparity between patient report and physician perception of pain from radiotracer injection for sentinel node biopsy is thought to center on the severity of the intervention, ethnic composition of population queried, and socioeconomic factors.
  
  
  OBJECTIVE
  The objectives of this study were, first, to explore agreement between physicians' and their breast cancer patients' pain assessment during subareolar radionucleotide injection; and second, to evaluate potential ethnic differences in ratings.
  
  
  METHODS
  A trial was conducted, from January 2006 to April 2009, where 140 breast cancer patients were randomly assigned to standard topical lidocaine-4% cream and 99mTc-sulfur colloid injection, or to one of three other groups: placebo cream and 99mTc-sulfur colloid injection containing NaHCO3, 1% lidocaine, or NaHCO3 + 1% lidocaine. Providers and patients completed numeric pain scales (0-10) immediately after injection.
  
  
  RESULTS
  Patients and providers rated pain similarly over the entire cohort (median, 3 vs 2, P = 0.15). Patients rated pain statistically significantly higher than physicians in the standard (6 vs 5, P = 0.045) and placebo + NaHCO3 (5 vs 4, P = 0.032) groups. No significant difference in scores existed between all African Americans and their physicians (3 vs 4, P = 0.27).
  
  
  CONCLUSIONS
  Patient-physician pain assessment congruence over the less painful injections and their statistically similar scores with the more painful methods suggests the importance of utilizing the least painful method possible. Providers tended to underestimate patients with the highest pain ratings-those in the greatest analgesic need. Lack of statistical difference between African American and physician scores may reflect the equal-access-to-care over the entire patient cohort, supporting the conclusion that socioeconomic factors may lie at the heart of previously reported discrepancies.
authors.affiliation: Department of Surgery, Walter Reed Army Medical Center, Washington, D.C, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Radowsky
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Baines
authors.forename: Robin S
authors.initials: RS
authors.lastname: Howard
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.forename: Chester C
authors.initials: CC
authors.lastname: Buckenmaier
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D010361:Patients / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012211:Rhenium / Q000008:administration & dosage; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; C030406:technetium Tc rhenium-sulfur colloid; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium; D008012:Lidocaine