Pain ratings by patients and their providers of radionucleotide injection for breast cancer lymphatic mapping

Pain Medicine, 05/03/2012

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.


  • 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.


  • 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).

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