title: Does transcutaneous electrical nerve stimulation (TENS) alleviate the pain experienced during bone marrow sampling in addition to standard techniques? A randomised, double-blinded, controlled trial.
abstract: OBJECTIVE
  Bone marrow aspiration and trephine (BMAT) biopsies remain important tests in haematology. However, the procedures can be moderately to severely painful despite standard methods of pain relief. To test the efficacy of transcutaneous electrical nerve stimulation (TENS) in alleviating the pain from BMAT in addition to standard analgesia using a numerical pain rating scale (NRS).
  
  
  METHODS
  70 patients requiring BMAT were randomised (1:1) in a double-blind, placebo-controlled trial. -35 patients received TENS impulses at a strong but comfortable amplitude (intervention group) and 35 patients received TENS impulses just above the sensory threshold (control group) (median pulse amplitude 20 and 7 mA, respectively). Patients and operators were blinded to group allocation. Pain assessments were made using a numerical pain scale completed after the procedure.
  
  
  RESULTS
  No significant difference in NRS pain recalled after the procedure was detected (median pain score 5.7 (95% CI 4.8 to 6.6) in control vs 5.6 (95% CI 4.8 to 6.4) in the intervention group). However, 100% of patients who had previous experience of BMAT and >94% of participants overall felt they benefited from using TENS and would recommend it to others for this procedure. There were no side effects from the TENS device, and it was well tolerated.
  
  
  CONCLUSIONS
  TENS is a safe, non-invasive adjunct to analgesia for reducing pain during bone marrow biopsy and provides a subjective benefit to most users; however, no objective difference in pain scores was detected when using TENS in this randomised controlled study.
  
  
  BACKGROUND
  NCT02005354.
authors.affiliation: Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: David L
authors.initials: DL
authors.lastname: Tucker
authors.affiliation: Department of Anaesthesia, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Rockett
authors.affiliation: Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: Mehedi
authors.initials: M
authors.lastname: Hasan
authors.affiliation: Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Poplar
authors.affiliation: Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Rule
mesh_terms: D000368:Aged; D001853:Bone Marrow; D001856:Bone Marrow Examination / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D013048:Specimen Handling / Q000009:adverse effects; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
keywords: BONE MARROW TREPHINES; EVALUATING INSTRUMEN; LABORATORY TESTS