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Bone marrow examination: a prospective survey on factors associated with pain

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Abstract

Bone marrow examination (BME) represents an essential tool for diagnosis and monitoring of haematological disorders. It remains associated with morbidity and discomfort; repeat examinations are frequent. We made a single-centre prospective survey on 700 BME between July 2007 and July 2008 with a structured anonymized questionnaire for patients undergoing and physicians performing BME, which includes at our institution always aspiration and trephine. All procedures were performed according to institutionalised standard operating procedures; 412 patients' (58.9%) and 554 physicians' (79.1%) questionnaires were returned. Pain was the only procedure-related complication; no pain was reported in 149 (36.7%), bearable pain in 242 (59.6%) and unbearable pain in 15 (3.7%) cases. Premedication associated complications were reported by 110 (32.7%) of the 336 (65.4%) patients with premedication before BME. None of these were > WHO grade 2; most frequently reported were tiredness (76 patients; 22.6%), dizziness (19 patients; 5.7%) and nausea (15 patients; 4.5%). Only two factors were significantly associated with unbearable pain: “pain during prior BME” (seven of 94 with versus one of 198 without previous pain; p < 0.01) and “information before BME” (four of 11 without versus 12 of 372 with adequate information before BME; p < 0.01). Inadequate information at any time showed a trend towards an association with unbearable pain (p = 0.08). No other factor was associated with unbearable pain. Good and adequate information appears to be the best way to reduce pain, even for a future BME.

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References

  1. Bain BJ (2003) Bone marrow biopsy morbidity and mortality. Br J Haematol 121:949–951

    Article  PubMed  Google Scholar 

  2. Bain BJ (2004) Bone marrow biopsy morbidity and mortality: 2002 data. Clin Lab Haematol 26:315–318

    Article  CAS  PubMed  Google Scholar 

  3. Bain BJ (2005) Bone marrow biopsy morbidity: review of 2003. J Clin Pathol 58:406–408

    Article  CAS  PubMed  Google Scholar 

  4. Bain BJ (2006) Morbidity associated with bone marrow aspiration and trephine biopsy - a review of UK data for 2004. Haematologica 91(9):1293–1294

    PubMed  Google Scholar 

  5. Kuball J, Schüz J, Gamm H, Weber M (2004) Bone marrow punctures and pain. Acute Pain 6:9–14

    Article  Google Scholar 

  6. Vanhelleputte P, Kristel N, Delforge M, Evers G, Vanderschueren S (2003) Pain during bone marrow aspiration: prevalence and prevention. J Pain Symptom Manage 26:860–866

    Article  PubMed  Google Scholar 

  7. Wolanskyj AP, Schroeder G, Wilson PR (2000) A randomized placebo-controlled study of outpatient premedication for bone marrow biopsy in adults with lymphoma. Clin Lymphoma 1:154–157

    Article  CAS  PubMed  Google Scholar 

  8. Giannoutsos I, Grech H, Maboreke T, Morgenstern G (2004) Performing bone marrow biopsies with or without sedation: a comparison. Clin Lab Haem 26:201–204

    Article  CAS  Google Scholar 

  9. Park SH, Bang SM, Nam E, Cho EK, Shin DB, Lee JH, Ahn JY (2008) A randomized double-blind placebo-controlled study of low-dose intravenous Lorazepam to reduce procedural pain during bone marrow aspiration and biopsy. Pain Medicine 9(2):249–252

    Article  PubMed  Google Scholar 

  10. Milligan DW, Howard MR, Judd A (1987) Premedication with Lorazepam before bone marrow biopsy. J Clin Pathol 40:696–698

    Article  CAS  PubMed  Google Scholar 

  11. Sandler ES, Weyman C, Conner K, Reilly K, Dickson N, Luzins J, McGkorray S (1992) Midazolam versus fentanyl as premedication for painful procedures in children with cancer. Pediatrics 89:631–634

    CAS  PubMed  Google Scholar 

  12. Burkle C, Harrison B, Koenig F, Decker P, Warner D, Gastineau D (2004) Morbidity and mortality of deep sedation in outpatient bone marrow biopsy. Am J Hematol 77:250–256

    Article  PubMed  Google Scholar 

  13. Pellier I, Monrigal J, le Moine P, Rod B, Railland X, Granry JC (1999) Use of intravenous ketamine-midazolam association for pain procedures in children with cancer. A prospective study. Paediatr Anaesth 9:61–68

    Article  CAS  PubMed  Google Scholar 

  14. Chakupurakal G, Delgado J, Nikolousis E, Pitchapillai S, Allotey D, Holder K, Bratby L, de la Rue J, Milligan DW (2008) Midazolam in conjunction with local anaesthesia is superior to Entonox in providing pain relief during bone marrow aspirate and trephine biopsy. J Clin Pathol 61:1051–1054

    Article  CAS  PubMed  Google Scholar 

  15. Dunlop TJ, Deen C, Lind S, Voyle RJ, Prichard JG (1999) Use of combined oral narvotic and benzodiazepine for control of pain associated with bone marrow examination. South Med J 92(5):477–480

    Article  CAS  PubMed  Google Scholar 

  16. Bortz J, Lienert GA, Boehnke K (2000) Verteilungsfreie Methoden in der Biostatistik 2. Auflage. Springer, Berlin

    Google Scholar 

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Correspondence to Alois Gratwohl.

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Degen, C., Christen, S., Rovo, A. et al. Bone marrow examination: a prospective survey on factors associated with pain. Ann Hematol 89, 619–624 (2010). https://doi.org/10.1007/s00277-010-0934-0

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  • DOI: https://doi.org/10.1007/s00277-010-0934-0

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