Global Approach to the Patient with Pain in Interventional Radiology

Radiographers' knowledge, clinical expertise and application of pain management strategies in the radiology department: Results from a qualitative focus group

BACKGROUND

Radiographers are frequently involved in imaging patients in pain thus requiring a heightened awareness and focus on this crucial issue.

PURPOSE

To explore the challenges radiographers encounter when imaging patients in pain and to identify strategies that could be implemented to improve overall patient-centered care.

METHODS

A qualitative research study with a single focus group (FG) was conducted using six radiographers working within Irish hospitals. The research questions focused on pain management challenges in the radiology department, particularly identifying radiographers' current practices and strategies to address these challenges. The FG was moderated and video-recorded to facilitate comprehensive analysis. The audio obtained from the FG was transcribed and then analyzed thematically.

RESULTS

Data from the FG identified four main themes: 1) consequences of pain management, 2) communication, 3) professional experience, and 4) barriers. In addition, the study highlighted the absence of current protocols, policies, and guidelines in practice for the effective management of challenges associated with imaging patients in pain within the radiology department.

CONCLUSION

The primary challenges identified include the stress experienced by both staff and patients, the potential for obtaining suboptimal images, concerns regarding patient safety, and adverse effects on image quality. This study elucidates the manner in which patient discomfort adversely impacts the imaging process and delineates the potential implications for radiographers aiming to achieve optimal image quality. At present, there are no established policies or procedures within the radiology department to direct the imaging of patients in pain.

Interventional Radiology Management of Bone Metastasis Pain: Strategies and Techniques

Osseous metastases are common in cancer patients, and pain is one of the most frequent associated symptoms. The management of cancer-related pain is still problematic worldwide with 40 to 50% of patients still being undertreated. A significant proportion of cancer patients will require discontinuation of traditional analgesic treatments such as opioids due to unsuccessful pain relief or severe unmanageable toxicity and may, therefore, benefit from alternative treatments. Over the last few decades, several interventional radiology (IR) minimally invasive treatment options have been introduced into the cancer pain management toolbox and can be proposed to cancer patients. This article reviews the main IR treatment options for painful bone metastases which include vertebral augmentation, percutaneous osteosynthesis, tumoral ablation, electrochemotherapy, intra-arterial therapies, and percutaneous neurolysis.

Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms

Objectives:

The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer.

Methods:

Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge.

Results:

Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days.

Conclusion:

Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.