How is pain managed during a bone marrow biopsy?

So there will be some discomfort during the procedure as we discussed, mostly I would say described as like pressure or sort of like intense sensations, but hopefully not a great deal of sharp pain. After the procedure, lidocaine lasts about four hours. So usually you have this window after the procedure where things feel okay. And then from four hours after the procedure till about 48 hours after, I would say most patients experience some mild soreness at the site. It's rare beyond that to have much discomfort at all. And what patients can do in that period of time is they can take Tylenol in the first 24 hours if they're allowed to, if it's not prohibited by their doctor. After 24 hours, they can take Tylenol and ibuprofen if that's allowed according to their treatment team. If they have other pain medications they normally take on a scheduled basis, they could take those. Ice is always helpful. So I do recommend that in the first 24 hours patients a few times a day just ice the site where we did the bone marrow biopsy and we always put an ice pack on when we're done. So those can be some strategies to help pain after the procedure. I wouldn't expect pain to last much longer than about 48 hours, maybe 72 hours. And I really, I would say it's really more soreness than pain. What we tell our patients is if you have pain that over-the-counter medications are not controlling we want to know about that because that could be a sign of something more serious going on that we would just like to be aware of. So in general, patients just describe this mild soreness for a few days after the procedure. There's a rare small percentage of patients that will have soreness lasting longer than that and we're always happy to talk that through with you and evaluate that in clinic if necessary. What can be done to lower the pain during the bone marrow biopsy examination? Bone marrow biopsies are by convention just a very off-putting, uncomfortable procedure to think about. But I would like patients to have confidence that the teams doing these bone marrow biopsies understand that, empathize with that, and take a lot of care to make the procedure as comfortable as possible. And so I want patients to feel empowered to ask lots of questions, to understand the procedure fully before they come in, and then when they're getting a bone marrow biopsy to ask for things that may make them more comfortable if that includes playing music during, have a family member join them in the room, dim the lights, whatever they can think of. But whatever you can do to reduce anxiety before the procedure and trust that we have your best interest at heart and that we're doing the procedure for a good reason, that we have a lot of expertise and want to get you through as pain-free as possible. I think the thing that helps the most is just trying to relax during the procedure. So trying to limit anxiety coming into the procedure, trying to ask all your questions beforehand so you feel really solid about why am I getting this procedure, what will I expect, what will it look like watching videos like this one so that you understand what to expect from start to finish. I usually instruct my patients to do some deep breathing while they're laying on the table, deep breaths in and out, relaxing their hips and shoulders because the more tense you are, the tighter the muscles are that surround our pelvic girdle and our pelvis bones that we have to access for the bone marrow biopsy and I think that can increase the pain. It's so typical to kind of like grab onto the bedsheets and really tense up and I think during the procedure, the more deep breathing you can do and the more relaxed you can keep your hips and shoulders and just be in a comfortable position, the more that that will help the patient experience less discomfort. I think if patients have had bad experiences in the past, they can certainly talk to their treatment team about if there are appropriate medications they could take beforehand but I would say that's the rare exception and not the rule. So bone marrow biopsies can be uncomfortable if not painful to patients and there's a number of techniques we can use both pharmacologic and non-pharmacologic to help reduce the pain and stress of a marrow. So pharmacologic ones are easy. There's pills that you can take. Now we can give pills for anxiety like Valium derivatives or we can use narcotics like Oxycodone and you can even use them together. For patients where this is really, really bad, we can even use conscious sedation and some institutions will allow this to be done under conscious sedation. Another one which is nice is there's a fentanyl lollipop called Actique, raspberry flavored, and what we can do is give the patient a lollipop to suck on. It's very short acting so it reduces the pain very quickly and then leaves the system very quickly thereafter. Non-pharmacologic ways are things such as guided meditation or music or simply speaking to the patient. The other thing is distracted methods. So sometimes when I do a bone marrow biopsy I'll say, all right, one, two, three, blow out really hard and that act of blowing out really hard kind of confuses the system and they don't feel the discomfort as much. So I think there's a bunch of things that we can do to really help relieve this for us patients as much as possible. There are some patients that can have bone marrows without anesthesia and it's no problem and there are people that with all of these methods shy of giving them conscious sedation can't tolerate it. So it's always a discussion like any side effect that they have, what is the optimal strategy for that individual patient?