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May 7, 2000

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Common Lung Exam Often Causes Unnecessary Pain: More Pain Control Needed

A common, invasive procedure used to test for lung disease may be causing patients unnecessary pain, according to a new study. While most physicians always use topical anesthetic before flexible bronchoscopy (FOB), many believe that other pain killers aren't needed. Now, Johns Hopkins researchers have shown that, even when sedatives and analgesics are routinely used, some patients suffer pain.

"This study clearly shows that the procedure causes pain," says Greg Diette, M.D., an assistant professor of pulmonary and critical care medicine at the Hopkins School of Medicine. "In an era when we have access to superior pain medications, there is no excuse not to use them for this exam." 

The results emerged from a study of 481 patients who underwent FOB at Johns Hopkins. Patients filled out two questionnaires, one before the exam and another one 48 hours after, designed to assess memories of the procedure, pain, satisfaction with care, and information provided about FOB. Physicians also kept a record of bronchoscopy technique, patients' underlying medical conditions, and doses of sedatives, analgesics, and topical anesthetic used. 

Although sedatives and analgesics were given almost 100 percent of the time, only 36 percent of patients reported pain control as excellent and 10 percent reported pain control as poor or fair. "The number of patients experiencing pain at some other centers is most likely much higher given that one survey of North American bronchoscopists found that only 51 percent used sedatives routinely," Diette said. 

The researchers also discovered that individuals were more likely to experience pain if they were sicker, less educated or had asthma. "This is the first study to systematically identify which patients are at high risk of experiencing pain," says Diette. "If people have lower levels of education, there may not be good communication with health care providers and they may not understand the procedure. They may not expect the pain and this makes the pain worse." 

Diette believes that better administration of pain medication and increased education about the procedure should help lower the number of people who experience pain during FOB. 

This research will be presented at the American Thoracic Society's conference on May 7.

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