Doctor, How Much Is This Going to Hurt? Debunking UFE’s Pain Myths
By Alicia Armeli

UFE_Pain

Even though uterine fibroid embolization (UFE) has the data to support its safety and efficacy, it still faces a major hurdle when it comes to gaining public acceptance.

“The major misconceptions with UFE are that it’s a painful procedure that requires general anesthesia or a hospital stay,” explains Dr. Michael J. Hallisey, MD, Chief Interventional Radiologist at Hartford Hospital in Hartford, Connecticut.  “UFE is now an outpatient procedure that can be performed with simple intravenous sedation.”

So where does this misunderstanding come from?

To answer this question, it’s important to first understand the basics of UFE. During UFE, tiny particles are injected into the uterine arteries to cut off blood supply to the fibroids. This causes them to shrink—thereby diminishing the severity of symptoms.

But UFE’s very reason for success is also believed to be the primary source of any pain associated with the procedure. When blood to the fibroids is restricted, this then causes a cascade of events.

“The pain occurs because the fibroids are starved of their blood supply,” describes Dr. Hallisey. “The cells of the fibroids rupture and expand in the uterus and so the initial phase feels like significant menstrual cramps.”

This cramping is part of what’s referred to as post-embolization syndrome (PES). Cramps following the procedure seem to worsen within the first 2 to 3 hours, reaching a constant intensity for 8 to 12 hours, and then subside significantly. Along with pelvic pain, other common symptoms of PES can include nausea, vomiting, and fatigue.1 Dr. Hallisey adds that neither fibroid size nor location seem to affect the level of discomfort experienced.

That being said, is UFE simply a matter of no pain, no gain? Not exactly.

But the trick to controlling pain happens well before the procedure.

“In the past, many interventional radiologists were giving pain medication at the start and that medication will just be getting absorbed at the time they’re performing the procedure,” says Dr. Hallisey. “It makes more sense to give pre-procedural medication, so they don’t feel the pain during the procedure.”

Although pain protocols differ between medical facilities, Dr. Hallisey administers a cocktail of pain medications before the procedure to ensure his patients remain comfortable. Both a fentanyl patch is applied to the skin and oral OxyContin is administered.

This method, he explains, makes it so the medications are already absorbed into the bloodstream before the procedure. It also helps to ensure patients won’t need intravenous narcotics afterwards, but instead can take oral over the counter pain medication—like Aleve®—when they go home. “As an outpatient procedure, 50 percent of patients are off their pain medication 24 hours after the procedure and another 50 percent in 48 hours.”

And the literature agrees. Seminars in Interventional Radiology wrote, “By administering longer-acting medications before the patient begins to experience pain, the dose required to control the pain is less. A lower dose of narcotics may decrease the level of nausea many patients experience as well.”1

As mentioned, narcotics are commonly the drugs of choice to ease pain, but at the same time they can cause nausea and vomiting.2 This can decrease the overall effectiveness of any pain medication taken.

“The biggest problem that patients complain about is that they aren’t absorbing their medications because they get nauseous,” says Dr. Hallisey. “Because of this, we give them a medication called Reglan to get their intestines moving and to better absorb the pain medication.” Additionally, giving anti-nausea medication before the procedure seems to be a proactive and beneficial step.1

But aside from medication, what else can women do to help their recovery?

“One of the best things women can do is hydrate themselves 24 hours before the procedure,” encourages Dr. Hallisey. “Hydration helps with recovering quicker. A heating pad on the abdomen can help afterwards.”

And to take it a step further, Dr. Hallisey believes the success of a procedure, and subsequent recovery, starts with open dialogue during the initial consultation.

“Women need to ask their doctors if they give pre-procedural pain medication and if they perform UFE entirely as an outpatient procedure,” advises Dr. Hallisey. “If a woman goes to a doctor who doesn’t offer this, then she needs to call around and find one who does. UFE isn’t that painful of a procedure and it works very well.”

 

ABOUT THE AUTHOR  Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR  Michael J. Hallisey is Chief Interventional Radiologist at Hartford Hospital in Hartford, Connecticut. Board certified in Vascular and Interventional Radiology, Dr. Hallisey specializes in several areas of medicine including uterine fibroid embolization, balloon angioplasty, and cancer chemoembolization, to name a few. He’s one of Castle Connolly America’s Top Doctors and was the recipient of the Compassionate Doctor Recognition award.

REFERENCES

  1. Spencer, E. B., Stratil, P., & Mizones, H. (2013). Clinical and periprocedural pain management for uterine artery embolization. Seminars in Interventional Radiology, 30(4): 354-363. doi: 10.1055/s-0033-1359729
  2. Smith, H. S., Smith, J. M., & Seidner, P. (2012). Opioid-induced nausea and vomiting.  Annals of Palliative Medicine, 1(2). doi: 10.3978/j.issn.2224-5820.2012.07.08