Non-pharmacological methods for pain relief during mammography: integrative review

Santos, Katherine Olga Correia Alves; Franco, Clarissa Lima; Ribeiro, Caique Jordan Nunes; Nunes, Mariangela da Silva; Oliveira, Maria do Carmo de

doi:10.5935/2595-0118.20220029-en

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REVIEW ARTICLE • BrJP 05 (02) • Apr-Jun 2022 • https://doi.org/10.5935/2595-0118.20220029-en copy

Non-pharmacological methods for pain relief during mammography: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES

Mammography is an examination of images of the breasts, obtained through radiography with compression of the breast tissue. Pain is a factor constantly reported by patients undergoing the procedure and, for this reason, there is a need to establish alternative non-pharmacological strategies that reduce the sensation of pain. The aim of this study was to carry out an integrative review on non-pharmacological methods used for pain relief during mammography examination.

The search was carried out in April 2021 in four databases (Pubmed, Medline, Scopus and CINAHL) using the descriptors “pain”, “pain management”, “mammography”, “music therapy” and “complementary therapies “. After reading and final analysis, four articles met the pre-established criteria, addressing the non-pharmacological management of pain during mammography. The studies showed different methods to reduce pain, such as the use of pads and changes in the compression protocol, as well as the intervention with music.

CONCLUSION

Evidence on the non-pharmacological management of mammography-related pain is still scarce. Among the strategies found, the customized compression protocol and the use of compressible pads showed analgesic efficacy, while the use of music did not result in a significant reduction in procedural pain. However, as this is an integrative review, there is a need to carry out evidence syntheses with greater methodological rigor to estimate the size of the analgesic effect of these interventions.

Keywords:
Complementary therapies Mammography; Pain; Pain management

Authors	Country of Origin	Design and Level of Evidence	Sample Size	Objectives
Zavotsky et al.¹³13 Chan HH, Lo G, Cheung PS. Is pain from mammography reduced by the use of a radiolucent MammoPad? Local experience in Hong Kong. Hong Kong Med J. 2016;22(3):210-5.	United States of America	Prospective quasi-experimental study 2B	100 women	Examine the relationship between screening mammography and music intervention.
de Groot et al.¹⁴14 Ferder K, Grunert JH. Is individualizing breast compression during mammography useful? investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Rofo. 2017;189(1):39-48.	Netherlands	Observational Study 3B	117 women	Gain insight into existing and potential mammography pain prevention strategies by simultaneously recording breast mechanics and pain throughout the breast compression cycle.
Chan, Lo and Cheung¹⁵	China	Cohort Study 2B	100 women	Evaluate the effectiveness of a radiotransparent pad (MammoPad; Hologic Inc, Bedfor [MA], US) during screening mammography to reduce pain in Chinese patients and the possibility of glandular dose reduction.
Ferder and Grunert¹⁶	Germany	Prospective observational study 3B	199 women	Determine how to reduce the presence of pain during mammographic compression. In doing so, the authors evaluated its association with compression force, compressed breast surface area, breast density (ACR), and previous operations.

Authors	Results
Zavotsky et al.¹³13 Chan HH, Lo G, Cheung PS. Is pain from mammography reduced by the use of a radiolucent MammoPad? Local experience in Hong Kong. Hong Kong Med J. 2016;22(3):210-5.	The mean unadjusted pain scores (X) were lower for the music therapy group (X = 4.38 ± 2.58) compared to the control group (X = 4.44 ± 2.93), which received no music. A statistical calculation was performed to evaluate the association between anxiety and pain scores. A significant, moderate, positive relationship was found between participants’ anxiety and pain scores (r = 0.54; p < 0.01). These results support an association between anxiety and pain in this population that may influence pain perception in both groups.
de Groot et al.¹⁴14 Ferder K, Grunert JH. Is individualizing breast compression during mammography useful? investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Rofo. 2017;189(1):39-48.	Breast compressions consisted of a deformation phase for flattening and a clamping phase for immobilization. The clamping phase lasted 12.8 ± 3.6 seconds (mean ± standard deviation), 1.7 times longer than the deformation phase of 7.5 ± 2.6 seconds. During the clamping phase, the mean pain intensity increased from 4.75 to 5.88 (24%) on the numerical rating scale (NRS) from 0 to 10, and the proportion of women presenting severe pain (NRS ≥ 7) increased from 23% to 50%. Moderate pain (NRS ≥ 4) was reported up to four days after mammography. Multivariate analysis showed that pain memory from the previous mammogram and pain in the breast prior to compression are significant predictors of pain. Women with smaller breasts experienced more pain.
Chan, Lo and Cheung¹⁵	Of the 100 patients, 66.3% of women reported at least a 10% reduction in the level of discomfort with the use of the MammoPad. No statistical differences were found for age, breast size, and discomfort level. The mean pain score was 5.7 ± 2.5 without the MammoPad vs 4.2 ± 1.8 with the use of the device.
Ferder and Grunert¹⁶	The thickness of the compressed breast was 65.2% of the uncompressed breast at a force of 10 daN (57.8% at 15 daN). When the force was increased from 10 daN to 15 daN, the average glandular dose (AGD) decreased by 17%. Compression tolerance was associated with breast size. More than 50% of mammograms with compression less than 9 daN were associated with higher pain levels. In the oblique projection, 60% of the women specified the axilla as the area of most pain.

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[1] Correspondence to: Katherine Olga Correia Alves Santos E-mail: kathebale_i9@hotmail.com

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Non-pharmacological methods for pain relief during mammography: integrative review

ABSTRACT

BACKGROUND AND OBJECTIVES

CONTENTS

CONCLUSION