Management of Pain and Anxiety during Bone Marrow Aspiration: An Italian National Survey

Liptrott, Sarah; Botti, Stefano; Bonifazi, Francesca; Cioce, Marco; Cecco, Valentina De; Pesce, Anna Rita; Caime, Alessandro; Rostagno, Elena; Samarani, Emanuela; Galgano, Letizia; Ciceri, Fabio; Orlando, Laura; Gargiulo, Gianpaolo

doi:10.1016/j.pmn.2020.09.005

Cited by 4 publications

(6 citation statements)

References 43 publications

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“…Though pain following BMAB has been reported as moderate to severe in up to one third of the patients; it is well recognized that sensitivity to and tolerance of pain differs ethnic groups (9)(10)(11). The mean pain score of 2.7 (± 1.39) in our study re ects a low pain score and is similar to a recent Italian national survey (12) This is but in con ict to experience with other procedures that, amongst ethnic groups; Indians have a higher mean pain score and need more medications for pain control. (10) This could be because of our policy of premedication with tramadol.…”

Section: Discussionsupporting

confidence: 85%

Procedural pain and serious adverse events following Bone Marrow Aspiration and Biopsy: Experience from an academic center in India

Philip¹,

Mathew²,

Singh³

et al. 2022

Preprint

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Background: The bone marrow aspiration and biopsy (BMAB) is an important and frequent investigative procedure for hematological diseases. Although thought to be safe and well tolerated; data is limited on the complications and degree of pain experienced by patients undergoing BMAB. Further scarce is data from India and other regions from the developing world especially given the evidence that cultural factors that could shape pain perception. Adverse events following bone marrow biopsy are rare but poorly documented. Aims: To estimate the level of pain and frequency of serious adverse events experienced by patients undergoing BMAB at our center. We also attempted to identify factors associated with increased pain perception.Methods: Study setting: This study was conducted at a tertiary level teaching hospital, the Christian Medical College & Hospital, Ludhiana. Ethics approval was obtained from the Institutional research committee (CMC/1495).Study period: 01 April 2015 through 30 Nov 2019Study Design: This is a comparative cross-sectional study where comparison of those with relatively more pain to those with less was done to elicit the factors associated with pain perception. Results: A total of 942 BMAB procedures were performed in this period ( Table1). The major serious adverse event was hemorrhage, which comprised 2 of the 9 serious adverse events. The following risk-factors were associated with increased pain on Multivariate analysis: those with prior BMAB had very low odds of pain (OR (95 % CI): 0.23 (0.15–0.37)). However, when more than one attempt of biopsy was made the odds of pain was much higher (OR (95 % CI): 1.62 (1.29–2.05)). Conclusions: In our analysis BMAB is safe and associated with a low level of perceived pain. Serious adverse events following BMAB are rare, but can have considerable impact on the individual patient.

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Section: Discussionsupporting

confidence: 85%

Procedural pain and serious adverse events following Bone Marrow Aspiration and Biopsy: Experience from an academic center in India

Philip¹,

Mathew²,

Singh³

et al. 2022

Preprint

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“…Due to the complex nature of pain, affective states such as anxiety and agitation can lead to a worse pain experience 34 . Benzodiazepines such as lorazepam or midazolam may be considered for mitigation of anxiety‐induced hyperalgesia before and during anti‐GD2 mAb infusions 35 ; their mild amnesiac effect may also help to reduce anxiety ahead of subsequent infusions. Premedication with benzodiazepines is also useful for reducing nausea and vomiting 36 and can be considered for specific patients receiving any of the anti‐GD2 mAb therapies, including naxitamab.…”

Section: Strategies For Pain Management During Anti‐gd2 Immunotherapymentioning

confidence: 99%

Pain mitigation and management strategies for anti‐GD2 infusions: An expert consensus

Nysom

Morad

Rafael

et al. 2023

Pediatric Blood & Cancer

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Monoclonal antibodies (mAbs) targeting disialoganglioside 2 (GD2) are an important treatment advance for high‐risk neuroblastoma, including in patients with refractory or relapsed disease. Dinutuximab and dinutuximab beta are administered for ≥8 hours (and up to 10 days for dinutuximab beta), whereas naxitamab is administered over 0.5 to 2 hours as tolerated. As acute pain is a class effect of anti‐GD2 mAbs, effective pain management is crucial to successful treatment. Here, we provide an overview of current pain‐management strategies for anti‐GD2 mAb infusions, with a focus on strategies suitable for naxitamab infusions, which cause a more rapid onset of often severe pain. We discuss opioid analgesics, ketamine, gabapentin, and other similar agents and nonpharmacologic approaches. Potential future pain‐management options are also discussed, in addition to the use of sedatives to reduce the anxiety that may be associated with infusion‐related pain. In this expert consensus paper, specific guidance for pain management during naxitamab infusions is provided, as these infusions are administered over 0.5 to 2 hours and may not need overnight hospitalization based on the physician's assessment, and require rapid‐onset analgesia options suitable for potential outpatient administration.

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“…15 The aspiratoin works to observe cell morphology and biopsy to quantify cells and diagnose infiltrative diseases of the bone marrow. 16 To obtain the sample, fluid is removed from the bone marrow (aspirated) or a piece of bone (biopsy) with a special needle, usually from the posterior iliac crest or sternum. While anesthesia is used to do the procedure, it is not enough to avoid pain.…”

Section: Bmba and Its Relationship With The Diagnosis Of Onco-hematol...mentioning

confidence: 99%

Psychological interventions for pain and anxiety management during bone marrow aspiration and biopsy

et al. 2023

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Cancer is the second cause of death in the world and the fourth in Mexico, among its types are onco-hematological diseases. Having cancer will have several repercussions on people suffering from it, including having to undergo very painful medical-invasive procedures, such as aspiration and bone marrow biopsy, a gold standard for the diagnosis of these pathologies. Bone marrow aspiration and biopsy anxiety is common, which increases pain and makes it a traumatic experience. Pharmacological strategies have not been entirely effective when it comes to pain management, so other solutions such as psychological interventions have been sought (psychoeducation, mindfulness and distraction techniques such as music therapy, self-directions, breathing techniques and relaxation use of virtual reality and mobile applications). Psychological interventions have been shown to be effective in managing pain and anxiety, however, for patients to have access to them, it is necessary to include the psychologist as part of the multidisciplinary team during the performance of these procedures.

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Management of Pain and Anxiety during Bone Marrow Aspiration: An Italian National Survey

Cited by 4 publications

References 43 publications

Procedural pain and serious adverse events following Bone Marrow Aspiration and Biopsy: Experience from an academic center in India

Procedural pain and serious adverse events following Bone Marrow Aspiration and Biopsy: Experience from an academic center in India

Pain mitigation and management strategies for anti‐GD2 infusions: An expert consensus

Psychological interventions for pain and anxiety management during bone marrow aspiration and biopsy

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