Chris Del Mar, MD
In women who expect a high degree of discomfort from screening mammography, does premedication with acetaminophen, ibuprofen, or 4% lidocaine gel decrease discomfort?
Randomized, placebo-controlled trial.
Blinded (participants, nurses, technologists, and radiologists).*
Immediately after mammography.
Screening mammography center in Boise, Idaho, USA.
418 women (median age 50 to 59 y) who were having screening mammography and expected discomfort ≥ 40 on a scale of 0 to 100 (worst). Women who were sensitive to the study medications or had liver or kidney dysfunction were excluded.
Women were instructed not to take any pain medication for 24 hours before mammography and to arrive at the center ≥ 60 min before their appointment, at which time they received 1 of 12 treatments: oral acetaminophen, 1000 mg (n = 38), oral ibuprofen, 800 mg (n = 29), oral placebo (n = 35), 1 oz of 4% lidocaine gel (n = 32), placebo gel (n = 42), acetaminophen plus lidocaine gel (n = 36), acetaminophen plus placebo gel (n = 31), ibuprofen plus lidocaine gel (n = 39), ibuprofen plus placebo gel (n = 35), oral placebo plus lidocaine gel (n = 33), oral placebo plus placebo gel (n = 36), or no medication (n = 32). The gels were applied to the skin of the woman's breasts and chest wall by a nurse and covered with plastic wrap. The gel was removed 30 to 65 minutes before the mammogram and was on the woman's skin for 30 to 75 minutes (median 48 min). Oral medications were taken 36 to 129 minutes (median 80 min) before the procedure.
Discomfort of mammography (assessed on a visual analogue scale, range 1 to 100 [worst]).
100% (intention-to-treat analysis).
Mean expected discomfort level was 58. Actual mean discomfort levels ranged from 24 with acetaminophen and lidocaine gel to 38 with placebo gel (Table). Lidocaine gel resulted in less discomfort during mammography than placebo gel or no gel (P = 0.01); discomfort did not vary by type of oral medication (P = 0.35). No evidence of interaction between gel and type of oral medication was found (P = 0.84).
4% lidocaine gel applied to the skin of the breasts and chest wall about 1 hour before screening mammography reduced discomfort in women who expected a high degree of discomfort. Oral medications did not reduce discomfort.
Combinations of topical 4% lidocaine gel, oral acetaminophen, oral ibuprofen, and placebo to reduce discomfort of mammography
†Assessed on a visual analogue scale (range 0 to 100 [worst]), adjusted for expected discomfort, age, breast density, mammography history, technologist, and mammography machine.
Mar CD. 4% lidocaine gel applied to the breasts before screening mammography reduced discomfort. Ann Intern Med. ;149:JC5–9. doi: 10.7326/0003-4819-149-10-200811180-02009
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Published: Ann Intern Med. 2008;149(10):JC5-9.
Breast Cancer, Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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