I was delighted to see Drs. Gunderman’s and Fogler’s call for educating radiologists about pain. Fortunately, some of the largest prospective randomized clinical trials on how to ameliorate pain through nonpharmacologic means have been conducted in radiology with generous support through National Institutes of Health and National Center for Complementary & Integrative Medicine and the US Army Materiel Command . Such support should encourage radiology residents and faculty to direct their attention to the patient experience as valid vehicle of scientific valor and funding history. We have learned quite a lot on how acute pain is processed. After all, as radiologists, we are experts in inflicting acute pain in the interventional suite or during mammographic or other biopsies, and contribute to patients’ stress due to the uncertainty of diagnostic testing .
The trials in radiology have uncovered an interesting mechanism by which patients experience pain in the radiology environment: pain increases linearly over time, with the steepness of increase relatively independent of stimulus severity and amount of drugs given . The good news is that a very short reframing of distressing thoughts, guidance to a relaxed state, and correct use of suggestions can revert this trend and result in a more comfortable, safer, and more cost-effective experience .
I would like to voice a word of caution to the approach of Drs. Gunderman and Fogler to use distraction. Distraction creates an external focus of attention and does not teach and empower patients to use their own coping skills. Instead it makes the patient dependent on the external distraction and risks impairing hemodynamic stability . Just talking and trying to be nice does not suffice and can even hurt the patient. Use of correct suggestions and enabling the patient to experience focused internal attention is paramount. Only this reduces pain, anxiety, complications, and drug use. As an extra benefit, the same methods also increase patient satisfaction and throughput .
Acknowledgment
This work was supported by the NIH Award Number R44AT006296 from the National Center for Complementary & Integrative Medicine (NCCIH). The content is solely the responsibility of the author and does not necessarily represent the official views of NCCIH.
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