Pain assessment and factors influencing pain during bone marrow aspiration: A prospective study

PLoS One. 2019 Aug 29;14(8):e0221534. doi: 10.1371/journal.pone.0221534. eCollection 2019.


Although bone marrow aspiration (BMA) is still considered a painful procedure, pain level remains poorly documented. We therefore conducted a prospective study intended to evaluate pain level in adult patients undergoing BMA at the sternal or iliac crest site to identify factors associated with pain. We enrolled a total of 448 patients who underwent 461 BMA and asked those patients to score their pain intensity after BMA using numerical pain rating scale (NPRS). The following factors: level of anxiety, quality of the information given to the patient, operator's experience, and bone texture were recorded using a standardized questionnaire. The median NPRS score was 3.5 (IQR [2.0; 5.0]) the sternal site (n = 405) was associated with an increased median NPRS score (3.5 [2.0; 5.0]) compared to the iliac crest (n = 56, 2.5 [1.0; 4.0]; p<0.0001). For those patients who underwent sternal BMA, the median NPRS score was significantly lower when using lidocaine infiltration (p = 0.0159) as compared with no anesthetic use. Additionally there was no significant effect of anesthetic cream found. After multivariate analysis, the model of NPRS score at the sternal site included patient anxiety (p<0.0001) and the use of lidocaine infiltration (0.0378). This study underlines the usefulness of a comprehensive management including pain relief and efforts to reduce anxiety including appropriate information given to the patient during BMA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Bone Marrow* / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / diagnosis*
  • Pain / etiology
  • Pain / physiopathology
  • Pain Measurement* / methods

Grant support

This work was supported by a grant from AP-HP (Assistance Publique - Hôpitaux de Paris) to NG. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.