Pain management and analgesic strategies in patients with carcinoma uterine cervix undergoing intracavitary or interstitial brachytherapy
Pain management is a critical aspect of brachytherapy (BT) for carcinoma of the uterine cervix. Pain intensity can vary based on technique, patient characteristics, and analgesic strategies. This study aims to evaluate pain severity and associated factors to guide optimal pain control. This retrospective observational study included 85 patients of carcinoma uterine cervix who received external beam radiotherapy (EBRT) followed by BT between October 2022 and May 2025. The BT schedule was 7 Gy × 4 fractions, using ICBT or ISBT. Pain was assessed during treatment using a numeric rating scale and categorized as mild (1-3), moderate (4-6), or severe (7-10). Analgesia was stratified into four regimens: paracetamol (PCT) alone, PCT and non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and fentanyl patient-controlled analgesia (PCA). Mode of anaesthesia and the drugs used were also analyzed. Of the 85 patients, 33 experienced mild pain, 33 moderate, and 19 severe pain. The median age was 53.2 years, with the severe pain group being significantly older (p = 0.009). Pain severity was significantly associated with brachytherapy technique (p = 0.013), with ISBT correlating with higher pain levels. Whilst use of analgesics (p = 0.078) showed trends towards significance, anaesthesia type did not (p = 0.21). Severe pain group were more likely to be administered fentanyl and opioids. Multimodal analgesic strategies, including fentanyl infusions and opioids, are crucial in managing severe pain. Tailored pain management should be considered to reduce complications and improve patient comfort and compliance during cervical cancer treatment.
