부산대학교 도서관

BACKGROUND:: Novel diagnostic techniques and neurologic biomarkers have greatly expanded clinical indications for cerebrospinal fluid (CSF) studies. CSF is most commonly obtained via lumbar puncture (LP). Although it is generally believed that LPs are well tolerated, there is a lack of supportive data for this claim and patients anticipate LP to be painful. The objective of this study was to prospectively investigate discordance between patient perception and tolerability of LP. METHODS:: Adult patients were surveyed before and after LP regarding their perceptions and experience of LP. Physician perceptions were gathered though a web-based survey. Relative risk and Spearman correlation were used to assess the relationship between responses. Paired binomial and paired ordinal responses were compared by McNemar and paired Wilcoxon rank-sum tests. RESULTS:: A total of 178 patients completed the surveys. About half of the patients (58%) reported anxiety pre-LP, at median 3.0 out of 10. Physicians over-predicted patients’ pre-LP anxiety (median score 5.0, p<0.001). Experienced pain was significantly less than predicted pain (median scores 0 and 3.0 respectively, p<0.001). Patients who predicted pain were more likely to report pain from LP (RR 1.3). Predicting pain was also correlated with anxiety prior to LP (p<0.001). CONCLUSIONS:: LP was generally well-tolerated. The majority of patients experienced minimal pain. Anticipation of pain was correlated with both feeling anxious and experiencing pain. The results of this study can be used to reassure patients and providers that LP is indeed not as painful as imagined, which may both reduce pre-LP anxiety and improve LP tolerability.