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

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.