Jane – Help for Painful Wire Localization
CancerGuide note, 2012: Cathy’s story inspired the author (Jane) to share the results of her research so that more women could be helped to have a less painful experience. Her own procedure took place in March 2012.
After many years of good mammography experiences, this year I endured a painful screening mammogram, an even more painful diagnostic mammogram, an excruciating and inaccurate wire localization with a vasovagal reaction, and a large excisional breast biopsy for a tiny cluster of microcalcifications located very posteriorly on my chest wall. I have never taken psychiatric drugs or been diagnosed with any psychiatric problems, and I can usually tolerate a fair amount of pain. However, for the past few months following the wire localization and excisional breast biopsy, I have struggled with post traumatic stress disorder, waking up in terror or sometimes even getting flashbacks during the day, remembering and sometimes actually reliving the wire localization and severe pain.
Clinical studies have shown that 70% of women undergoing wire localizations with mammographic guidance experience moderate to severe pain, and about 7% experience vasovagal episodes. How many of these women are terrified of their next mammogram or biopsy? How many experience PTSD and don’t tell anyone? After my own painful and traumatic experience, I have tried to explore the possibility of pain and/or anxiety medication for future wire localizations, both for my own benefit and that of other patients. As a retired R.N., I am committed to doing anything I can to help other women by speaking out about my own experience and advocating for change.
I wrote letters describing my experience and talked with my surgeon, the mammography department head, the anesthesiology department head, the director of nursing, and the medical director of my hospital. I then made suggestions to improve the problems I had experienced with painful mammography, poor communication of results to patients, and painful and inaccurate wire localization. Changes are now being made at my local hospital, including sedation and pain relief for women undergoing wire localization. If you are facing this procedure, discuss the options in the articles below with your physician.
I have found a medical article which offers a helpful procedure, Benzodiazepine Premedication, Can It Improve Outcome in Patients Undergoing Breast Biopsy Procedures? by Janet van Vlymen, MD, FRCPC; Monica M. Sa Rego, MD, and Paul F. White, PhD, MD, FANZCA at the Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center at Dallas (Anesthesia, Mar 1999, Vol.90, No. 3: 740-747). This study demonstrated decreased incidence of moderate-to-severe discomfort during needle localization, as well as decreased vasovagal episodes, after premedication with 1.0 mg midazolam (Versed) or 2.0 mg diazepam emulsion (Dizac) given intravenously 5 minutes before the patient was transferred from the Day Surgery Unit (DSU) to the radiology department. In the radiology department, patients then received local injection of buffered lidocaine before the procedure.
Another successful method of effective pain relief for wire localization is described in Paravertebral blockade for minor breast surgery by Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT (2002 Feb;94(2):355-9). This study found that patients with a paravertebral block who underwent a radiograph wire localization procedure experienced less pain during the procedure, had higher patient satisfaction scores, and were so happy with it that many of them later refused to undergo breast surgery without it.
A case study using paravertebral block for wire localization is reported in Management of Breast Needle Localization Patients with Severe Phobia by Farzin Goravanchi, Steve Wang, Alicia Kowalski, Elizabeth Rebello, and Spencer Kee at the MD Anderson Cancer Center in Houston, TX. The patient had phobia of mammogram needle localization because of a previous painful, prolonged and difficult wire localization, and she refused surgery unless she was offered effective pain relief. Paravertebral block was performed in the sitting position under sedation with routine monitors and a nurse escort to and from the remote needle localization service, with a resulting “anxiety free and pain free breast needle localization.”