Neuroendovascular Procedures Linked to Patient Back Pain

A prospective study, published in Journal of Neuroimaging, showed that more than 40% of individuals who had neuroendovascular procedures experienced back pain during the procedure. The authors noted that the high frequency of back pain was reported despite a large percentage of patients receiving intravenous pain medications during the procedure. These results suggest a need to identify strategies to reduce back pain and for clinicians to be more proactive in addressing pain during neuroendovascular procedures.  

The study included 242 patients, mean age 58.7 ± 16.2, who underwent a neuroendovascular procedure, mean duration 82.3 (range 15‐410) minutes. All were asked about the presence and location of back pain immediately afterwards, and 41.3% reported back pain during the procedure. For those who reported pain, the median severity was 5 on a 10-point scale. More than 75% of those individuals reported pain in the lumbar spine. Presence of back pain immediately after procedures correlated significantly with a history prior neck or back surgery (P=.02). No correlation between age, body mass index (BMI) or procedure duration was observed. 

“Pain management is increasingly recognized as an important marker of high-quality care and is related to patient satisfaction,” said Adnan I. Qureshi, MD, professor of clinical neurology, MU School of Medicine. “The relatively high prevalence of back pain in patients undergoing neuroendovascular procedures while awake must be recognized, and strategies to reduce the occurrence need to be identified. Since our intravenous fentanyl dose was not based on patients’ body weight, we tried to identify any role underdosing may have played in those with high body mass index or those with previous neck or back pain with tolerance to opioids. However, our analysis found underdosing was not a factor. Further research will be needed to determine what combination of analgesics and sedation methods are optimal to achieve a successful outcome without patient discomfort.”