Safety and pain in electrodiagnostic studies

Abstract

Discomfort is an unavoidable part of electrodiagnostic (EDX) studies. The most readily modifiable mediator of electromyography (EMG)-associated pain is muscle selection. Interventions that may reduce pain include vapocoolant spray, ibuprofen, and techniques such as slapping or stretching the skin. Needlestick injuries to health care workers carry the risk of transmitting bloodborne illnesses, but other infectious complications of EDX studies are very rare. EMG probably contributes to asymptomatic hemorrhage in approximately 1% of patients, but clinically significant bleeding has only been reported a few times. Therapeutic anticoagulation does not significantly increase this risk. With standard procedures, there have been no reports of patients developing cardiac arrhythmia from nerve conduction studies. No special precautions are necessary in patients with implantable cardiac devices or intravenous lines. There is a small risk of pneumothorax associated with EMG of the diaphragm and chest wall muscles. Several techniques have been suggested to improve the safety of diaphragm EMG. Muscle Nerve 55: 149-159, 2017.

The provision of written information and its effect on levels of pain and anxiety during electrodiagnostic studies: A randomised controlled trial

“…Due to the nature of electrophysiological evaluations, most patients express a degree of discomfort, pain and anxiety, with pain being the most common complication. This is well tolerated by most patients, however in some patients, poor tolerance may limit the validity and accuracy of the test by restricting the extent of the study and hence the diagnostic utility of these evaluations [ 1 , 2 ]. This is particularly pertinent in the context of the ultimate value of these tests when taking into account the outcomes relative to the cost of the investigation.…”

Ultrasound analysis of cervical paraspinal muscles for needle EMG examination

“…The risk of symptomatic hematoma from needle EMG examination is very rare 10 . To date, there have been no reports of a clinically significant paraspinal hematoma.…”

Needle EMG muscle identification: A systematic approach to needle EMG examination

“…As the article by London (2017) addresses many of these items, only a brief summary will be listed in Appendix D and includes:Anticoagulants and bleeding disordersInfectionCardiac valvular diseaseObesitySkin conditions…”