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Annals of Hematology
Published in: Annals of Hematology 2/2013

Open Access 01-02-2013 | Review Article

Strategies of pain reduction during the bone marrow biopsy

Authors: Nikolaj Hjortholm, Emil Jaddini, Kazimierz Hałaburda, Emilian Snarski

Published in: Annals of Hematology | Issue 2/2013

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Abstract

Examination of the bone marrow biopsy and aspirate allows diagnosis and assessment of various conditions such as primary hematologic and metastatic neoplasms, as well as nonmalignant disorders. Despite being performed for many years, according to many different protocols, the procedure still remains painful for the majority of patients. This paper summarizes the current knowledge of pain reduction measures in the bone marrow biopsy and aspiration.
Literature
1.
Accardi MC, Milling LS (2009) The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review. J Behav Med 32(4):328–339PubMedCrossRef
2.
Annequin D, Carbajal R, Chauvin P, Gall O, Tourniaire B, Murat I (2000) Fixed 50 % nitrous oxide oxygen mixture for painful procedures: a French survey. Pediatrics 105(4):E47PubMedCrossRef
3.
Audran M, Maury E, Bouvard B, Legrand E, Baslé MF, Chappard D (2012) Is transiliac bone biopsy a painful procedure? Clin Nephrol 77(2):97–104PubMed
4.
5.
6.
Berenson et al (2011) Using a powered bone marrow biopsy system results in shorter procedures, causes less residual pain to adult patients, and yields larger specimens. Diag Pathol 6(23)
7.
Birch CD, Fischer S, Zibell A, Jensen ME (1982) Diagnostic bone marrow studies extended routinely by iliac crest biopsy, using the method of Schaadt–Fischer. Acta Pathol Microbiol Immunol Scand 90:229–234
8.
Brunetti GA, Tendas A, Meloni E, Mancini D et al (2011) Pain and anxiety associated with bone marrow aspiration and biopsy: a prospective study on 152 Italian patients with hematological malignancies. Ann Hematol 90(10):1233–1235PubMedCrossRef
9.
Burkle CM, Harrison BA, Koenig LF, Decker PA, Warner DO, Gastineau DA (2004) Morbidity and mortality of deep sedation in outpatient bone marrow biopsy. Am J Hematol 77(3):250–256PubMedCrossRef
10.
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 61:1051–1054PubMedCrossRef
11.
Degen C, Christen S, Rovo A, Gratwohl A (2010) Bone marrow examination: a prospective survey on factors associated with pain. Ann Hematol 89:61924CrossRef
12.
13.
Dunlop TJ, Deen C, Lind S, Voyle RJ, Prichard JG (1999) Use of combined oral narcotic and benzodiazepine for control of pain associated with bone marrow examination. South Med J 92(5):477–480PubMedCrossRef
14.
Ellis LD, Jensen WN, Westerman MF (1964) Needle biopsy of bone and bone marrow. An experience with 1,445 biopsies. Arch Intern Med 114(2):213–221PubMedCrossRef
15.
Friedman AG, Mulhern RK, Fairclough D et al (1991) Midazolam premedication for pediatric bone marrow aspiration and lumbar puncture. Med Pediatr Oncol 19(6):499–504PubMedCrossRef
16.
Ghedini G (1908) Studi sulla patologia del midollo osseo umano vivente. I. Puntura explorative tecnica. Clin Med Ital 47:724
17.
Giannoutsos I, Grech H, Maboreke T et al (2004) Performing bone marrow biopsies with or without sedation: a comparison. Clin Lab Haematol 26:201–204PubMedCrossRef
18.
Goldenberg AS, Rishton M (1999) Bone-marrow biopsy needle incorporating a snare-coil specimen-capturing device: description and preclinical studies. Biomed Instrum Technol 33(6):522–529PubMed
19.
Goldenberg AS, Tiesinga JJ (2001) Clinical experience with a new specimen capturing bone marrow biopsy needle. Am J Hematol 68(3):189–193PubMedCrossRef
20.
Gudgin EJ, Besser MW, Craig JIO (2008) Entonox as a sedative for bone marrow aspiration and biopsy. Int J Lab Hema 30(1):65–67
21.
Hernandez-Garcia MT, Hernandez-Nieto L, Perez-Gonzalez E, Brito-Barroso ML (1993) Bone marrow trephine biopsy: anterior superior iliac spine versus posterior superior iliac spine. Clin Lab Haematol 15(1):15–19PubMedCrossRef
22.
Jamshidi K, Windschitl HE, Swaim WR (1971) A new biopsy needle for bone marrow. Scand J Haematol 8(1):69–71PubMedCrossRef
23.
Johnson H, Burke D, Plews C, Newell R, Parapia L (2008) Improving the patient experience of a bone marrow biopsy—an RCT. J Clin Nurs 17(6):717–725PubMedCrossRef
24.
Kanagasundaram SA, Lane LJ, Cavalletto BP, Keneally JP, Cooper MG (2001) Efficacy and safety of nitrous oxide in alleviating pain and anxiety during painful procedures. Arch Dis Child 84(6):492–495PubMedCrossRef
25.
Knowles S, Hoffbrand AV (1980) Bone-marrow aspiration and trephine biopsy. Br Med J 281(6234):204–205PubMedCrossRef
26.
Kuball J, Schüz J, Gamm H, Weber M (2004) Bone marrow punctures and pain. Acute Pain 6(1):9–14CrossRef
27.
Kuivalainen AM, Niemi-Murola L, Widenius T et al (2010) Comparison of articaine and lidocaine for infiltration anaesthesia in patients undergoing bone marrow aspiration and biopsy. Eur J Pain 14(2):160–163PubMedCrossRef
28.
Liden Y, Landgren O, Arner S, Sjolund K, Johansson E (2009) Procedure related pain among adult patients with hematologic malignancies. Acta Anaesthesiol Scand 53:354–363PubMedCrossRef
29.
Liossi C, Hatira P (1999) Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. Int J Clin Exp Hypn 47(2):104–116PubMedCrossRef
30.
Milligan DW, Howard MR, Judd A (1987) Premedication with lorazepam before bone marrow biopsy. J Clin Pathol 40(6):696–698PubMedCrossRef
31.
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 Med 9(2):249–252PubMedCrossRef
32.
Pascali VL, Lazzaro P, Fiori A (1987) Is sternal bone marrow needle biopsy still a hazardous technique? Report of three further fatal cases. Am J Forensic Med Pathol 8(1):42–44PubMedCrossRef
33.
Peabody FW (1927) Pathology of bone marrow in pernicious anemia. Am J Pathol 3(3):179–202.9PubMed
34.
Puschel K, Mattern R, Mittmeyer HJ, Schneider V (1985) Errors and hazards: fatalities through sternal puncture. Dtsch Med Wochenschr 110(42):1611–1613PubMedCrossRef
35.
Riley RS, Hogan TF, Pavot DR et al (2004) A pathologist’s perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination. J Clin Lab Anal 18(2):70–90PubMedCrossRef
36.
Rywlin AM (1976) Histopathology of the bone marrow. Little, Brown & Co, Boston, pp 126–132
37.
Scott LJ, Perry CM (2000) Tramadol: a review of its use in perioperative pain. Drugs 60(1):139–176PubMedCrossRef
38.
Shabanloei R, Golchin M, Esfahani A, Dolatkhah R, Rasoulian M (2010) Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration. AORN J 91(6):746–751PubMedCrossRef
39.
Snow A, Dorfman D, Warbet R, Cammarata M, Eisenman S, Zilberfein F, Isola L, Navada S (2012) A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures. J Psychosoc Oncol 30(3):281–293PubMedCrossRef
40.
Sola MC, Rimsza LM, Christensen RD (1999) A bone marrow biopsy technique suitable for use in neonates. Br J Haematol 107(2):458–460PubMedCrossRef
41.
Steedman B, Watson J, Ali S, Shields ML, Patmore RD, Allsup DJ (2006) Inhaled nitrous oxide (Entonox) as a short acting sedative during bone marrow examination. Clin Lab Haematol 28(5):321–324PubMedCrossRef
42.
Steinke B (1992) Complications after bone marrow biopsy. Dtsch Med Wochenschr 19(117(25)):1003–1004
43.
Talamo G, Liao J, Bayerl MG, Claxton DF, Zangari M (2010) Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy. Support Care Cancer 18(3):301–305PubMedCrossRef
44.
Vanhelleputte P, Nijs K, Delforge M et al (2003) Pain during bone marrow aspiration: prevalence and prevention. J Pain Symptom Manage 26(3):860–866PubMedCrossRef
45.
Watmough S, Flynn M (2011) A review of pain management interventions in bone marrow biopsy. J Clin Nurs 20(5–6):615–623PubMedCrossRef
46.
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(2):154–157PubMedCrossRef
Metadata
Title
Strategies of pain reduction during the bone marrow biopsy
Authors
Nikolaj Hjortholm
Emil Jaddini
Kazimierz Hałaburda
Emilian Snarski
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Annals of Hematology / Issue 2/2013
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-012-1641-9

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