Post-operative Pain and Prostate Brachytherapy
Pain with prostate brachytherapy is negligible.
PUROPOSE: To identify the true incidence of pain associated with transperineal ultrasound guided prostate brachytherapy (PB).
METHODS AND MATERIALS: Between November 25, 2002 and January 8, 2003, 114 consecutive patients underwent PB at a single institution. Using the National Cancer Institute’s Pain Intensity Scale, patients verbally reported the level of pain they experienced in 4 areas: pre-operative room, recovery room, discharge and at time of post-operative phone call, which occurs the next working day following implant. Note that pre-operative pain was not limited to that related to prostate cancer, but included any type of pain from headache to arthritis. General anesthesia was used, however, narcotics and benzodiazopines were not. On the 0-10 numeric pain intensity scale, O represents “no pain” and 10 is equivalent to the “worst possible pain”. Each patient’s pain rating was documented by a nurse within that specific area, as well as location of pain and any action taken to alleviate pain.
RESULTS: Mean pain ratings for the pre-operative room, recovery room, time of discharge and at time of post-operative phone call were .54 ± 1.62, 1.00 ± 1.76, .59 ± 1.09 and .46 ± 1.02, respectively. Arthritis was the most common type of pain reported in the pre-operative area. Perineal discomfort, followed by urethral burning were the first and second most commonly reported sites of pain in all 3 of the remaining study areas. Table 1 clearly demonstrates pain ratings and areas of pain reported by this study group. Of the 40/114 patients who experienced some degree of pain in the recovery room, 500 mg acetaminophen, administered to 17 patients, was the most frequently used method to alleviate pain. Of the 32/114 patients who continued to experience minimal pain at time of discharge, 25 refused further medication. At time of post-operative phone call, 27 patients indicated they still had slight pain, but 13 continued not to take any action. The remainder of patients seemed to do well with acetaminophen and/or applying ice packs to the perineum.
CONCLUSION: The pain ratings in each area are exceptionally low. The highest pain rating was found in the recovery room, which is logical since the recovery room is where patients will immediately begin to feel the effects of the procedure. Moreover, perineal soreness is expected since this is the site of needle insertion, as is urethral burning, due to post-implant cystoscopy. Further, because this slight discomfort is easily controlled with acetaminophen and/or ice packs, it is easy to see why some patients choose not to take any action and bear the slight pain. Typically, pain ratings of 3 or less are considered acceptable. Therefore, to have 1.00 as the highest mean rating suggests pain associated with PB is negligible.
