Improvements in UFE Pain Management Protocol
By Alicia Armeli

PainManagement

Advances in uterine fibroid embolization (UFE) patient care are happening every day—particularly in the area of pain management. Although considered minimally invasive, UFE is associated with some pain following the procedure. However, thanks to physicians like Cheryl Hoffman, MD, new protocols are being investigated to ensure patient comfort is a priority throughout all stages of UFE.

“The procedure itself is not painful,” says Dr. Hoffman, Health Sciences Associate Clinical Professor at the David Geffen School of Medicine at UCLA and Medical Director at the Manhattan Beach Radiology Imaging and Interventional Center. “Patients only feel a little poke in the groin, which is typically the same as getting a little numbing medicine in your mouth when you go to a dentist. We also give patients medicine to lessen their anxiety and to handle any discomfort.”

During UFE, a catheter is inserted through a small incision in the upper thigh. Using special imaging equipment, the catheter is threaded through the femoral artery in the leg and then into the uterine arteries. Small particles called embolics are injected in the uterine arteries to block the blood flow that feeds the fibroids, causing them to shrink and die.

“It’s at the end of the procedure after we have cut off the blood supply to the fibroids that the patients can have cramping and pelvic pain,” clarifies Dr. Hoffman. “That’s the pain we’re actively looking for the best formula to help control—toward the end of the procedure and for the initial hours afterward.”

Currently, pain protocol can differ but commonly includes a preemptive pain reliever, an anti-inflammatory medication, and an anti-nausea medication to help counteract the effect of the pain relievers.1 “There are a variety of protocols out there and we’re always striving to make it as comfortable as possible for patients,” Hoffman explains. “The regimens are usually based around narcotics and non-steroidal anti-inflammatory drugs (NSAIDs) with the hope of trying to control the pain after the procedure and any nausea associated with the medications.”

Since UFE’s inception in 19952, pain management protocols are always improving due to ongoing clinical trials. “Coming up with the right regimen and trying to figure out what works and what doesn’t is the key,” explains Dr. Hoffman, who is currently conducting her own UFE pain management trial.

“There are two new medications that fall within the category of controlling pain—IV Tylenol and IV Advil. They’ve been used internationally, frequently, and have been found to be safe but have never been applied to a placebo, double-blinded, randomly controlled UFE trial.”

Working alongside Jonathan S. Jahr, MD, anesthesiologist and Professor of Clinical Anesthesiology at the David Geffen School of Medicine at UCLA, Hoffman has high hopes for this study.

“When these drugs are used together, we’d like to see if there’s a synergistic effect and indeed control the pain more,” says Dr. Hoffman. “We’re comparing that to how much narcotics patients need, which can be associated with increased nausea. When these two drugs are used together, we’re trying to see if we use less narcotics and if we use less narcotics do we then have less nausea and use less anti-nausea medicines?”

Better pain management and improved patient care are significant, but Dr. Hoffman’s reasons for conducting the study encompass much more. By making UFE as comfortable as possible for women, she hopes to make uterus-sparing procedures more mainstream.

“Hysterectomy is an overused procedure and patients should not be getting the number of hysterectomies they’re getting. There are a lot of good things a uterus does besides make a baby,” Hoffman points out. “If a woman has symptomatic fibroids, we should be able to do something minimally invasive, but she shouldn’t have to have her whole uterus removed. Every physician should always be discussing all of a patient’s options.”

Dr. Hoffman’s study is listed on the US National Institutes of Health Clinical Trials website.

ABOUT THE AUTHOR Alicia Armeli has a Master of Science in Nutrition and Whole Foods Dietetics (MSN/DPD) and is a registered dietitian nutritionist, a certified dietitian, and a holistic life coach. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Cheryl Hoffman is a Health Sciences Associate Clinical Professor at the David Geffen School of Medicine at UCLA and Medical Director at the Manhattan Beach Radiology Imaging and Interventional Center. She is American Board Certified in Vascular and Interventional Radiology as well as Diagnostic Radiology. Through patient care and research, Dr. Hoffman builds public awareness around uterine fibroids and all treatment options available with the goal of helping women everywhere live optimally. For more information regarding the study, please contact Dr. Hoffman, MD at [email protected] 

REFERENCES

  1. Konstantatos, A. H., Kavnoudias, H., Stegeman, J. R., Boyd, D., Street, M., Bailey, M., Lyon, S. M., & Thomson, K. R. (2014). A randomized, double-blind, placebo-controlled study of preemptive oral oxycodone with morphine patient-controlled anesthesia for postoperative pain management in patients undergoing uterine artery embolization for symptomatic uterine fibroids. Cardiovascular and Interventional Radiology, 37(5): 1191-1197. doi: 10.1007/s00270-014-0913-2.
  2. Ravina, J. H., Herbreteau, D., Ciraru-Vigneron, Bouret, J. M., Houdart, E., Aymard, A., & Merland, J. J. (1995). Arterial embolisation to treat uterine myomata. Lancet, 346(8976): 671–672.