Procedure‐related pain among adult patients with hematologic malignancies

Background: Cancer patients undergo numerous invasive diagnostic procedures. However, there are only sparse data on the characteristics and determinants for procedure‐related pain among adult cancer patients. Methods: In this prospective study, we evaluated the characteristics and determinants of procedure‐related pain in 235 consecutive hematologic patients (M/F:126/109; median age 62 years, range 20–89 years) undergoing a bone marrow aspiration/biopsy (BMA) under local anesthesia. Questionnaires were used to assess patients before‐, 10 min and 1–7 days post BMA. Using logistic regression models, we calculated odds ratios (ORs) and 95% confidence intervals (CIs). Results: 165/235 (70%) patients reported pain during BMA; 92 (56%), 53 (32%) and 5 (3%) of these indicated moderate visual analogue scale (VAS)≥30 mm], severe (VAS>54 mm) and worst possible pain (VAS=100 mm), respectively. On multivariate analyses, pre‐existing pain (OR=2.60 95% CI 1.26–5.36), anxiety about the diagnostic outcome of BMA (OR=3.17 95% CI 1.54–6.52), anxiety about needle‐insertion (OR=2.49 95% CI 1.22–5.10) and low employment status (sick‐leave/unemployed) (OR=3.14 95% CI 1.31–7.55) were independently associated with an increased risk of pain during BMA. At follow‐up 10 min after BMA, 40/235 (17%) patients reported pain. At 1, 3, 6 and 7 days post BMA, pain was present in 137 (64%), 90 (42%), 43 (20%) and 25 (12%) patients, respectively. Conclusions: We found that 3/4 of hematologic patients who underwent BMA reported procedural pain; one third of these patients indicated severe pain. Pre‐existing pain, anxiety about the diagnostic outcome of BMA or needle‐insertion, and low employment status were independent risk factors.