Identification of factors related to pain from musculoskeletal injections.
Caitlin D Faust, Masaru Teramoto, Sarah T Pietruszka and 6 others
PMID 40698745WHAT IT FOUND
Buffering lidocaine with sodium bicarbonate lowered injection pain by 0.68 points on a 10-point scale.
Female patients, ultrasound guidance, and trainee presence were linked to higher pain scores. Older age and larger injectate volumes showed trivial associations with lower pain.
Key findings
01The use of sodium bicarbonate was associated with significantly lower patient-reported pain during musculoskeletal injections.
02Female gender, ultrasound image guidance, and the presence of a trainee were significantly associated with greater patient-reported pain levels during musculoskeletal injections.
03Although age, BMI, and injectate volume were statistically significant in the model, their beta coefficients and 95% CIs were fairly close to 0.00, indicating that their associations to intraprocedure pain were likely minimal/trivial, if any.
STILL TO COME
How it was doneWhat they found
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What it does not show
Retrospective design with significant selection bias: physicians chose guidance methods and techniques based on clinical judgment, meaning harder injections likely used ultrasound. Pain was recorded by staff rather than self-reported by patients, introducing potential response bias or underreporting. Postprocedural pain data was 46.5% missing and excluded from analysis. Injection techniques were not standardized across physicians. The study did not control for preprocedural anxiety or diagnosis severity.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the higher pain scores with ultrasound guidance or trainee presence as causal harm. The retrospective design means these factors likely mark more complex or difficult injections rather than causing the pain directly.
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