Survey of Interventional Pain Physicians on Bending Spinal Needles for Chronic Pain Procedures

Background: Interventional pain proceduresinvolve placement of fine-gauge spinal needles,which practitioners will frequently bend to facilitateboth driving the needle through tissue, andto increase accuracy of placement at a specificspinal structure or nerve target. This bend is commonlyperformed by hand, leaving the proceduralistat risk for fingerstick injury, and the patientat risk of site contamination. However, few casestudies have been published, and there are almostno data on physician preference or practice.Objectives: The purpose of this study was tosurvey interventional pain physicians on theirpractice of spinal needle manipulation beforeperforming lumbar medial branch nerve blocks.Specific aims were to assess the prevalence ofmanual needle bending, and to determine possibleassociations with practitioner experience,clinical environment, and fingerstick injury.Study Design: A survey.Setting: Annual 2018 American Society forInterventional Pain Physicians conference inOrlando, Florida.Methods: A convenience sample of participantswere screened for eligibility and asked to voluntarilyparticipate in a de-identified IRB-approvedsurvey (IRB201703055). The survey consisted of5 questions, 2 with binary answer choices and theremaining 3 with multiple answer choices. Datawere collected on an iPad via Qualtrics software.Data were analyzed by descriptive statistics(counts, percentages).Results: Of 480 interventional pain physician attendeesat the conference, 154 (32.1%) completedthe survey. The majority (114/154; 74%) reported‘always’ bending the distal tip of spinal needles,and a further 21 (14%) reported ‘sometimes’; 19(12%) said they do not bend their needles. Only25 (18%) respondents used an instrument to bendtheir needles; 112 (82%) bend their needles byhand. Eight respondents (6%) reported a fingerstickinjury while bending a spinal needle, onewhile using an instrument, and 7 during a manualbend. Approximately half of respondents had beenpracticing for greater than 15 years; 78% work ina private practice environment.Limitations: Due to the setting, the recruitmentmethod presents the possibility of selection bias.Furthermore, although the response rate mayappear low, it is higher than similarly performedstudies.Conclusions: Spinal needle manipulation is commonprior to performing interventional pain procedures,and most spinal needle manipulations areperformed by hand. Rate of fingerstick injury waslow in this sample, but cannot be evaluated withoutcomparative data. Factors to be considered in asubsequent study are the effects of needle bendvariability relative to practitioner experience andalternative means of needle manipulation.Key words: Interventional pain procedures, spinalneedles, facet joint injections, needle bending,fingerstick injuries