Does a bone marrow biopsy hurt?

Yes, usually some. MedlinePlus is direct about it: the inside of the bone cannot be numbed, so this test may cause some discomfort. Numbing medicine covers the skin and the surface of the bone. It does not reach deeper than that.

What the sensations actually are

MedlinePlus separates three moments, which is more useful than one word like "painful."

First, a sharp sting when the numbing medicine goes in. That part is brief.

Second, the biopsy needle itself. MedlinePlus describes it as a brief, usually dull pain as the needle takes a core of bone marrow.

Third, if an aspiration is done as well, a brief sharp pain as the liquid marrow is drawn into a syringe. Aspiration and biopsy are two different things. An aspiration pulls out a small amount of marrow in liquid form. A biopsy takes a solid core. Both are often done in the same visit, sometimes through the same needle hole.

The sample is usually taken from the pelvic bone, sometimes the breastbone, and occasionally elsewhere.

Comfort medicine is offered, not assumed

MedlinePlus says medicine to help a person relax is given "if needed." That word matters. Sedation is not automatic, and practice varies by clinic.

The National Cancer Institute describes the two categories. A sedative is medicine that helps a person relax and stay very still, or sleep, during a biopsy. Anesthesia keeps a person from feeling pain, and comes in local, regional, and general forms.

Neither NCI nor MedlinePlus publishes a rule about which is used for bone marrow. There is no stated default. So the useful question before the appointment is a specific one: what numbing medicine, and is anything offered for anxiety on top of it? Asking in advance works better than asking on the table, because oral sedatives need time and usually a ride home.

How to prepare

MedlinePlus lists four things the care team needs to know beforehand: any medicine allergies, all current medicines, any bleeding problems, and whether there is a pregnancy.

Bleeding problems matter most here. Blood thinners and low platelet counts change the plan.

Afterward, and what the sample is for

Pressure and a bandage go on the skin. MedlinePlus says there may be some bleeding at the puncture site, and that more serious risks, such as heavy bleeding or infection, are very rare.

Deep soreness at the site for a day or two is common. Growing redness, swelling, drainage, or a fever of 100.4 °F (38 °C) or higher is not, and warrants a call the same day.

The sample goes to a pathologist, who examines the cells under a microscope. NCI notes that marrow is often studied further with two techniques. Cytogenetic analysis looks for broken, missing, rearranged, or extra chromosomes. Immunophenotyping uses antibodies to identify cells by the markers on their surface. Both are standard when a blood cancer such as leukemia or lymphoma is being considered.

That extra testing is why results can take longer than a simple biopsy elsewhere in the body. Our guide to biopsy covers the wider set of procedures, and the piece on biopsy vs aspiration explains the difference between the two samples taken here.

MedlinePlus last reviewed its bone marrow biopsy page on June 17, 2024.

Sources

• https://medlineplus.gov/ency/article/003934.htm
• https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis
• https://medlineplus.gov/ency/patientinstructions/000913.htm