No precise data on adverse effects were provided in any of the RCTs. Munkvad et a/.37 reported "adverse events" in 19/62 (31%) participants but the nature of the adverse events and the proportions in the active treatment and placebo groups were not specified. Three of the other four trials35,36,39 reported that most participants experienced pain. In two36,38 of the five trials local anaesthetic was used routinely before the injection of bleomycin. Hayes et al39 reported pain in most participants, irrespective of dose. In the trial by Bunney et al.,35 of the 24 participants, all of whom received bleomycin, one withdrew because of the pain of the injections and another one withdrew because of pain in the period after injection.

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