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Musculoskeletal injection pain shows clear patterns—higher in women, individuals with higher BMI, ultrasound-guided procedures, and trainee involvement, but lower with sodium bicarbonate, older age, and greater injection volume.
Musculoskeletal injections are widely used in clinical practice to mitigate joint and muscle pain. While valuable in many cases, the level of pain experienced during these procedures can vary from one patient to another. Understanding the clinical, demographic, and procedural factors that influence pain perception is crucial for boosting patient comfort and guiding counseling strategies.
Hence, Caitlin D Faust et al. aimed to explore the clinical, demographic, and injection-related factors associated with patient-perceived pain during musculoskeletal injections.
In this cross-sectional, retrospective study conducted in outpatient orthopedic clinics, adult patients (≥18 years) who received musculoskeletal injections were included. Patients with cognitive disabilities, aphasia, or those unable to communicate in English were eliminated. Pain intensity was recorded before, during, and after each procedure using a 0–10 numerical rating scale (NRS). Demographic details and procedural characteristics were extracted from medical records, and data were examined to assess their influence on intraprocedural pain.
The study analyzed 1,371 musculoskeletal injections performed in 935 patients, of whom 62.4% were female. The mean age was 58.6 ± 16.1 years, average body mass index (BMI) was 29.6 ± 7.3 kg/m2, and the median pain score reported during the procedure was 2 on a 0–10 scale. Multivariate linear regression exhibited several predictors of intraprocedural pain:
(a) Factors associated with higher intraprocedural pain included:
(b) Factors associated with lower intraprocedural pain included:
Logistic regression also displayed that the presence of a trainee nearly doubled the odds of patients reporting procedural pain (odds ratio = 1.86). The findings highlight important variables that influence patient comfort during musculoskeletal injections. Awareness of these factors allows clinicians to better counsel patients, set expectations, and adopt strategies to ameliorate pain.
Techniques such as using sodium bicarbonate, avoiding unnecessary trainee involvement, and considering palpation-guided injections where appropriate could help reduce discomfort. To sum up, while musculoskeletal injections are generally well-tolerated, patient characteristics, procedural factors, and injection techniques play a vital role in perceived pain. This insight can guide more personalized care and optimize the overall patient experience.
Physical Medicine & Rehabilitation Journal
Identification of factors related to pain from musculoskeletal injections
Caitlin D Faust et al.
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