Work-Related Pain Common Among Staff in Cath Labs

February 26, 2015

ROCHESTER, MN — Physicians, nurses, and technicians working on cases in the interventional lab are at a heightened risk of work-related musculoskeletal pain, according to a new survey of staff by the Mayo Clinic[1].

More than half of employees with occupational exposure to procedures involving radiation requiring the use of a lead apron reported experiencing work-related pain and were significantly more likely to have sought medical care for their injuries or discomfort, report investigators.

The survey-based study, which was led by Dr Nicholas Orme (Mayo Clinic, Rochester, MN) and published February 23, 2015 in the Journal of the American College of Cardiology, included 1543 employees, average age 43 years old, in the Mayo Clinic Health System who work in the various interventional laboratories. Overall, 24% of those surveyed were in the cardiology department and 76% worked in radiology. Roughly half of those who responded were technicians/technologists, 20% were registered nurses, 15% were physicians, and 7% were residents or fellows.

When compared with 499 physicians, nurses, and technicians in the aged-matched control arm, there was no significant difference in the use of pain medication, number of missed work days, the type of pain experienced, or the pain-rating index.

However, 54.7% of those with occupational exposure to fluoroscopically guided procedures requiring the lead apron had a history of work-related pain vs 45% in the control arm, a statistically significant difference. Among the workers, 44% of physicians, 60% of nurses, and 62% of technicians reported work-related pain. Overall, 30% of individuals sought medical care for their orthopedic pain vs just 24% in the control arm, a statistically significant difference.

Those who reported work-related pain were significantly more likely to be female, spend more time each week exposed to radiation, and wear the lead apron more often throughout the week, report investigators.

"This study did not demonstrate a statistically significant increase in the incidence of cancer, hypothyroidism, or cataracts in personnel exposed to radiation," according to Orme and colleagues. "Although it did not reach statistical significance and the overall number of cases was small, among respondents with any history of cancer, there was a higher incidence of breast cancer (19% vs 9%; P=0.15) in employees with radiation exposure."

Honor, Duty, and the Vigor of Youth

In an editorial[2], Dr James Goldstein (William Beaumont Hospital, Detroit, MI) states that interventionalists and other personnel enter the field young and full of bravado and invincibility. In this environment, there is an honor and sense of duty in caring for patients.

"In the interventional lab, it is perhaps only both human and pragmatic to 'scrub in' and care for our patients without further thought of the risks of longer-term occupational injury," he writes. "Akin to National Football League [NFL] players, we strap on our pads and helmets and enter the 'field of play.' Optimism and hope are marvelous human attributes, but as the NFL has painfully learned, denial is not an effective strategy."

The data, says Goldstein, now strongly indicate that working in an interventional laboratory is associated with a high prevalence of orthopedic problems, particularly the spine. As a result, some doctors have quit the specialty altogether. "Solutions must be found so we can practice our art and heal our patients with long, healthy, and robust careers."

Some solutions are being developed, he noted, including the use of suspended individual lead aprons, shield gloves, and shielded scrub caps for cranial protection. Robotic technology will also help, but Goldstein said there remains a need for more advances so doctors, nurses, and techs can continue to work. "Our patients, society, and our spines will be the beneficiaries," he writes.

The authors and editorialist report no relevant financial relationships.

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