RESEARCH post-o pe r at i v e pain definitive diagnosis. A clear understanding of the pain experience associated with soft tissue biopsies would aid clinicians in preparing patients for these procedures. The purpose of this study was to examine the incidence and severity of post-operative pain and the use of analgesics following incisional and excisional biopsy of lesions of the oral mucous membranes. Subjects and methods Eighty-five consecutive patients, aged 15 years or over, undergoing biopsy of lesions of the oral mucous membranes under local anaes- thesia in an oral medicine clinic were recruited into the study. Informed consent was obtained for each biopsy. Each patient was given a pain diary to complete for each of the 7 post-operative days. Patients were instructed to note 3 items for each day: the overall level of pain, the worst pain experienced and whether analgesics had been taken. Overall and worst pain levels were recorded using visual analogue scales (VAS), each consisting of a 100 mm calibrated line on white paper, marked 0 to 10 at 10 mm intervals. Patients were informed that a score of 0 indicated ‘no pain at all’ while a score of 10 indicated ‘the pain could not be worse’. Patients were instructed to record in the diary each morning the pain experience of the previ- ous day, by marking an appropriate point on the VAS for worst pain and an appropriate point on the VAS for overall pain and by answer- ing ‘yes’ or ‘no’ to the question on analgesic use. Records were also kept of age, sex and biopsy site. Pain scores were further categorised as ‘none’, ‘mild’, ‘moderate’, or ‘severe’ using previously established criteria, 5 zero scores on the VAS being regarded as ‘no pain’, 1–3 as ‘mild’ pain, 4–6 as ‘moderate’ and 7–10 as ‘severe’. Patients were reviewed on completion of the 7-day diary to ensure normal healing and absence of infection. Results Nine returned diaries out of the 85 were incorrectly completed and were discarded from the study. Most failures resulted from incorrect use of the VAS by the patient. Thus, 76 diaries were available for analysis. Clinically no biopsied area had become infected and all biopsy sites were seen to be healing normally. Twenty-eight of the patients (37%) were men and 48 (63%) were women. The median age was 51 years (IQR 33 to 65), range 15 to 85 years. The sites of biopsy are shown in Table 1. Twenty- five patients (33%) recorded no pain at all on any day. On the first day 30 patients (39%) recorded no pain; this rose to 60 patients (79%) by the seventh day (Table 2). On day one 59 patients (78%) recorded overall pain levels corresponding to none or mild and 55 (72%) recorded worst pain levels corre- sponding to none or mild. The corresponding figures for the sev- enth day were 72 (95%) and 72 (95%) (see Table 3). Out of a total of 1064 VAS scores, only 110 (10%) corresponded to moderate or severe pain and only 38 (4%) corresponded to severe pain; pain scores corresponding to severe pain were recorded by only 11 patients (14%). The experiences recorded for overall and worst pain were similar; while there were some differences Patients’ pain experience following oral mucosal biopsy under local anaesthesia H. P. O. Kearns, 1 B. E. McCartan, 2 and P-J. Lamey, 3 Objective To examine the incidence and severity of post- operative pain and use of analgesics following biopsy of oral mucosal lesions. Design A patient survey using a self-completed pain diary. Subjects and Methods Seventy-six patients attending an oral medicine clinic for investigation of oral mucosal disease recorded overall and worst pain experiences and analgesic usage over 7 post-operative days following biopsy using visual analogue scales in patient completed diaries. Results One third of patients reported no post-operative pain on any day. Most patients recorded no pain or mild pain. The percentage experiencing pain dropped from the first day (61%) to the seventh day (21%). Most patients did not use any analgesics. Analgesic use was not related to the presence of pain. Only a small minority of patients recorded severe pain. Conclusion Biopsy of oral mucosal lesions does not cause undue pain in most patients. B iopsy of lesions of the oral mucous membranes is a common minor surgical procedure, usually performed under local anaesthesia. Although previous workers have investigated pain, swelling and trismus following surgical removal of teeth 1,2 there do not appear to be any reports on pain experience in patients with healing wounds following oral mucosal biopsy. Similarly, there appear to be no reports in the literature of pain following dermato- logical and gynaecological soft tissue biopsies. This may be, in part, caused by the subjective nature of pain and the inherent problems of measuring a continuous subjective response over a period of time. Previous studies of post-operative pain following surgical removal of third molars have shown that there is no relationship between the operative trauma and the magnitude of the post-opera- tive pain. 1,3,4 The pain experienced following third molar surgery under local anaesthesia has been shown to be of short duration and reaches its maximum intensity in the early post-operative period. 1 The same workers found that the magnitude of post-operative pain does not appear to be related to the operator who carried out the surgery. There are conflicting reports on whether a relationship exists between sex and pain experience. 1,3,4 Soft tissue biopsy of oral lesions is often necessary to obtain a 1 Research Fellow in Oral Medicine, Department of Oral Surgery, Oral Medicine and Oral Pathology, School of Dental Science, Trinity College Dublin, Dublin 2, Ireland; 2* Senior Lecturer/Consultant in Oral Medicine, Department of Oral Surgery, Oral Medicine and Oral Pathology, School of Dental Science, Trinity College Dublin, Dublin 2, Ireland; 3 Professor of Oral Medicine, School of Clinical Dentistry, The Queen’s University of Belfast, Grosvenor Road, Belfast BT12 6BP, United Kingdom *Correspondence to: B. E. McCartan, Department of Oral Surgery, Oral Medicine and Oral Pathology, School of Dental Science, Trinity College, Dublin 2, Ireland email: bmccrtan@dental.tcd.ie REFEREED PAPER Received 21.01.00; accepted 26.06.00 © British Dental Journal 2000; 190: 33–35 BRITISH DENTAL JOURNAL, VOLUME 190, NO. 1, JANUARY 13 2001 33