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First, the insertion of the needle through the skin, subcutaneous tissue and muscle tissue usually causes moderate pain. Further, as the needle passes through the bone, a strong, pressure-like sensation is experienced. The part of the aspiration procedure causing the most pain, however, is the actual aspiration action. This pulling sensation, which lasts as long as the syringe plunger is retracted, has been described by some as agonizingly painful, while others perceive less intense pain, depending on the patient's pain threshold and level of apprehension and fear. Further, while the bone coring procedure has not been described as acutely painful as the aspiration procedure, it does cause moderate to severe discomfort.

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