An audit of pain in ultrasound-guided breast core biopsy

Introduction

We audited pain from ultrasound-guided core biopsies (CB) for routine service quality monitoring, to provide baseline data against which to compare new techniques, and to help us develop methodological expertise in pain assessment. Although there is no standard against which to audit CB pain, published comparators are available.

Methods

Two self-report pain scales were administered to 64 female patients immediately after ultrasound-guided 14G CB under local anaesthesia. Although we aimed for consecutive patients, some were de-selected by staff on grounds of apparently high levels of cancer anxiety. The scales were a 100 mm visual analogue scale (VAS) and a four-category verbal rating scale (VRS) - None, Mild, Moderate, Severe. Responses were anonymous and no attempt was made to collect data on relevant variables. VAS scores were compared between VRS categories using the Mann-Whitney U test.

Results

Sixty questionnaires were adequate for analysis. VAS scores were not normally distributed and ranged from 0 to 80, median 7.5, interquartile range 15 (mean 15.6 ± SD 22.3). The paired VAS and VRS results correlated well and the median VAS scores for the different VRS categories demonstrated clear distinctions between categories (P <0.001).

Conclusions

The correlation between VAS scores and VRS categories is evidence supporting the validity of the scales. Our overall mean VAS score was lower than the most comparable values in the literature. We will use our audit to illustrate a discussion of the principles, including scale selection, and the pitfalls of pain assessment in relation to existing relevant literature.