The world’s most painful medical procedures, ranked by a physician: From knee replacements to lumbar punctures

While medical procedures are entirely necessary and life-saving, it doesn’t mean they’re painless. 

In fact even those carried out under general anaesthetic, which is supposed to prevent you from feeling pain during the procedure, can cause significant discomfort on the road to recovery. 

Some procedures, though, are definitely more painful than others – no matter how high your pain tolerance may be. 

We asked Dr Dean Eggitt, a consultant primary care physician, to rank the world’s most painful surgeries and procedures – to help patients know what to expect, and crucially, what they can do to make their recovery as easy as possible. 

Major surgery is not always more painful than a minor operation, partly due to the amount of pain medication a patient will be given, he says.

’While everyone will experience pain differently, there are definitely some procedures that are more painful than others like spinal fusion, open chest surgery and total knee replacement,’ he told the Daily Mail. 

’All of these procedures disrupt bones and nerves and cannot have total immobilisation afterwards. 

’So while the actual surgery might not be too painful, the extensive physiotherapy required for full recovery can be very painful.’

So what are the most painful procedures, and can we really do anything to ease the pain? 

Bone marrow biopsy: why it’s considered one of the most painful procedures 

A bone marrow procedure is done for one of two reasons: to collect stem cells for donation or to test for cancer cells. 

Bone marrow is the spongy tissue and fluid found in the centre of some bones, which makes different types of blood cells: red blood cells, white blood cells and platelets.

Stem cell transplants are used to treat conditions in which the bone marrow is damaged and is no longer able to produce health blood cells such as leukaemia, lymphoma and sickle cell anaemia. 

Patients and donors are put under either local or general anaesthetic before a needle is inserted into the hip bone to collect liquid bone marrow. 

Those under local anaesthetic, which is used to numb the area whist the patient is awake, may feel a pulling sensation when bone marrow cells are drawn out.  

After the procedure, you will be left with a puncture wound and often bruising around the biopsy site. Patients often experience aching in the bone for a couple of days after, which can be alleviated with mild painkillers. 

As with all procedures, there is also a small risk of infection which can cause fluid to ooze from the biopsy site.

Lumbar puncture (spinal tap): what the pain feels like 

Also known as a lumbar puncture, this procedure involves inserting a needle into the lower back, between the bones in the spine – and is one of the most feared medical procedures because the patient has to be awake for it work. 

It is normally used to find out if symptoms are being caused by a brain or spine condition but can also be used to treat an infection or some types of cancer as well as to administer anaesthetic. 

A needle is slowly inserted into the lower back between the bones in the spine. Many patients report feeling pressure, discomfit and pins and needles a few seconds after the needles is inserted. 

Then, if you’re having tests, fluid from inside the spine will be collected in small tubes which are then sent away for testing. If you’re being given medicines or an anaesthetic, these are injected directly into the spine. 

After having a lumbar puncture it is not uncommon to experience headache, back pain, bleeding, and swelling where the needle was inserted. 

In rarer cases it can also cause long-term back pain, infection, never damage which can result in a loss of feeling in the arms and legs, hearing loss, double vision and blood clots. 

Open-heart surgery and sternotomy: why opening the chest is so painful 

Open chest surgery refers to any kind of surgery in which a surgeon makes a large incision in the chest to open the rib cage and provide access to the heart and lungs. 

It is most  commonly performed for open heart surgeries and is done under general anaesthesia. After the surgery, the sternum halves are wired together using stainless steel wires or similar devices to stabilise the bone. 

The breastbone alone will take around 12 weeks to health.  

Muscles and the skin are then sewn shut. Unsurprisingly, patients will experience moderate to severe pain initially after, with movement, coughing and deep breathing all making the pain worse. 

It it also normal to have aches, pains, stiffness and numbness in your back, neck, shoulders, arms and chest after the operation, according to the NHS. 

This is due to the surgery affecting your breastbone, ligaments, and wound healing but will improve over time. 

The health services advices patients to take painkillers regularly enabling them to move, sleep and cough more comfortably, stating it is better to prevent pain by taking medication regularly rather than waiting until the pain is very bad.  

Total knee replacement: why this common surgery can be surprisingly painful 

 Knee replacements vary for people in terms of how painful they are. 

But because they require significant rehabilitation, many people would class the procedure as one of the most painful, Dr Eggitt explains. 

The knee usually moves smoothly because end the ends of the bones are covered with a layer of tough cartilage. 

But when cartilage starts to wear away as a result of injury or osteoarthritis, the bones rub against one another causing pain and stiffness around the joint. 

’The best thing you can do to help recover from a total knee replacement is to pre-plan,’ Dr Eggitt says. 

’Don’t just think about painkillers but also seating, sleeping arrangements and daily activities.

’But it won’t be pain free as the procedure is hugely traumatic to both bones and nerves,’ he added. 

The procedure is carried out either under general or local anaesthetic, which is injected into the spine to numb feeling from the waist down. 

In a total replacement the lower end of the thigh bone and the upper end of the shin bone are cut away and replaced with metal and plastic parts that are screwed into place.

The knee cap is then put back into place over the knee joint and the incision is closed with stitches or clips before being covered with a bandage. 

Recovery time can vary based on age and general health but Dr Eggitt says the best thing you can do is start walking as soon after the operation as possible – with the help of crutches or a walking frame. 

He said: ’The longer it takes to get moving, the harder it will be.’

The NHS also recommends getting up and walking around for five minutes every hour to prevent blood clots as well as keeping the leg raised as much as possible to reduce swelling.   

Hysteroscopy: the womb procedure a third of women say is unbearably painful 

A hysteroscopy is a test to examine the inside of a woman’s womb by passing a thin telescope-like device through the cervix. 

According to the Royal College of Obstetricians and Gynecologists, a third of women undergoing the procedure report pain levels of seven or more out of 10. 

As such, patients should be offered local or general anaesthetic, the board advises, and a woman’s medical history, including trauma with contraceptive coil fittings should be taken into account. 

Whilst uncomfortable, the test can help diagnose or treat many different issues including fibroids or small growths, repeated miscarriages and bleeding after the menopause. 

To help manage the pain, the NHS recommends taking ibuprofen or paracetamol an hour before the procedure and requesting general anaesthetic or an injection to help you relax, but not all hospitals or clinics offer this.