title: Pain and anxiety during bone marrow biopsy.
abstract: A bone marrow biopsy is considered to be painful, often causing anxiety. We observed large differences between patients and wondered which factors cause pain and anxiety. In a prospective study, 202 patients were analyzed. Experienced hematologists and fellows in training (17% of biopsies) performed bone marrow aspirates and biopsies from the posterior iliac crest. Demographics, disease category, performance score, source of information, number of previous biopsies, experience of the hematologist, and length and quality of the biopsy were recorded. Pain and anxiety were measured using a visual analog scale and verbal rating score. Data were subjected to univariate and multivariate regression. The median pain score was 1.9 (range 0-10); 21% did not experience any pain. Anxiety scored 1.8 (range 0-10), and correlated positively with pain (p = .000). By univariate analysis, young age, poor performance, the physician as source of information, and prolonged procedures were associated with more pain. In multivariate analysis, anxiety, information from the physician, and a prolonged procedure persisted. Length or artifacts of the core biopsy did not correlate with pain. In conclusion, bone marrow biopsies performed in an optimal setting by experienced hematologists cause only mild pain, with, however, some patients experienced serious problems. To reduce pain, not only careful local anesthesia, but also the addition of systemic analgesics and especially anxiety reduction seems to be useful.
authors: Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: e.a.tanasale@umcg.nl.
authors: Betty
authors: B
authors: Tanasale
authors: Outpatient Clinic, University Medical Center Groningen, Groningen, The Netherlands.
authors: Jenne
authors: J
authors: Kits
authors: Department of Pathology and Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors: Philip M
authors: PM
authors: Kluin
authors: Support staff, University Medical Center Groningen, Groningen, The Netherlands.
authors: Albert
authors: A
authors: Trip
authors: Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands.
authors: Hanneke C
authors: HC
authors: Kluin-Nelemans
mesh_terms: D059787:Acute Pain / Q000451:nursing* / Q000517:prevention & control* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001007:Anxiety / Q000451:nursing* / Q000517:prevention & control* / Q000523:psychology; D001706:Biopsy / Q000009:adverse effects* / Q000451:nursing*; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006402:Hematologic Diseases / Q000451:nursing / Q000473:pathology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000700:Analgesics; D000925:Anticoagulants; D006993:Hypnotics and Sedatives