Pain relief in hysteroscopy

Authors

  • Jessica Yun Pui LAW

DOI:

https://doi.org/10.12809/hkjgom.23.1.08

Keywords:

Hysteroscopy, Pain, procedural

Abstract

Pain is a major barrier to successful outpatient hysteroscopy. Multiple factors can cause pain during the procedure including patient factors such as cervical stenosis and anxiety and procedural factors such as hysteroscope diameter and operative procedures. Pain relief strategies tailored to needs for Hong Kong women may enhance patient satisfaction and the success rate of outpatient hysteroscopic procedures.

References

The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol 2020;135:e138-e148.

Hysteroscopy, Best Practice in Outpatient Hysteroscopy (Green Top Guideline No. 59) RCOG/BSGE Joint Guideline. 2011.

van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 2007;114:664-75.

Vitale SG, Haimovich S, Laganà AS, et al. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol 2021;260:70-7.

Du Y, Xu Y, Qin Z, et al. The oncology safety of diagnostic hysteroscopy in early-stage endometrial cancer: a systematic review and meta-analysis. Front Oncol 2021;11:742761.

Saridogan E, Tilden D, Sykes D, Davis N, Subramanian D. Cost-analysis comparison of outpatient see-and-treat hysteroscopy service with other hysteroscopy service models. J Minim Invasive Gynecol 2010;17:518-25.

Munro MG, Kasiewicz JL, Desai VB. Office versus institutional operative hysteroscopy: an economic model. J Minim Invasive Gynecol 2022;29:535-48.

Diwakar L, Roberts TE, Cooper NA, et al. An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding. BJOG 2016;123:625-31.

Garuti G, Centinaio G, Luerti M. Outpatient hysteroscopic polypectomy in postmenopausal women: a comparison between mechanical and electrosurgical resection. J Minim Invasive Gynecol 2008;15:595-600.

Namazov A, Gemer O, Ben-Arie A, et al. Endometrial polyp size and the risk of malignancy in asymptomatic postmenopausal women. J Obstet Gynaecol Can 2019;41:912-5.

Golan A, Cohen-Sahar B, Keidar R, Condrea A, Ginath S, Sagiv R. Endometrial polyps: symptomatology, menopausal status and malignancy. Gynecol Obstet Invest 2010;70:107-12.

Bettocchi S, Bramante S, Bifulco G, et al. Challenging the cervix: strategies to overcome the anatomic impediments to hysteroscopy: analysis of 31,052 office hysteroscopies. Fertil Steril 2016;105:e16-e17.

Ahmad G, Attarbashi S, O’Flynn H, Watson AJ. Pain relief in office gynaecology: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2011;155:3-13.

Jivraj S, Dass M, Panikkar J, Brown V. Outpatient hysteroscopy: an observational study of patient acceptability. Medicina (Kaunas) 2004;40:1207-10.

Cooper NA, Middleton L, Smith P, et al. A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding. Gynecol Surg 2016;13:313-22.

Keyhan S, Munro MG. Office diagnostic and operative hysteroscopy using local anesthesia only: an analysis of patient reported pain and other procedural outcomes. J Minim Invasive Gynecol 2014;21:791-8.

Mahmud A, Smith P, Clark TJ. Benchmarking services in outpatient hysteroscopy (OPH): a quality improvement project. Eur J Obstet Gynecol Reprod Biol 2021;259:211-21.

Ahmad G, Saluja S, O’Flynn H, Sorrentino A, Leach D, Watson A. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev 2017;10:CD007710.

Kokanali MK, Cavkaytar S, Guzel Aİ, et al. Impact of preprocedural anxiety levels on pain perception in patients undergoing office hysteroscopy. J Chin Med Assoc 2014;77:477-81.

Vitale SG, Caruso S, Ciebiera M, et al. Management of anxiety and pain perception in women undergoing office hysteroscopy: a systematic review. Arch Gynecol Obstet 2020;301:885-94.

Sorrentino F, Petito A, Angioni S, et al. Impact of anxiety levels on the perception of pain in patients undergoing office hysteroscopy. Arch Gynecol Obstet 2021;303:999-1007.

Gupta JK, Clark TJ, More S, Pattison H. Patient anxiety and experiences associated with an outpatient “one-stop” “see and treat” hysteroscopy clinic. Surg Endosc 2004;18:1099-104.

Mazzon I, Favilli A, Grasso M, et al. Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial. Fertil Steril 2014;102:1398-403.

Carta G, Palermo P, Marinangeli F, et al. Waiting time and pain during office hysteroscopy. J Minim Invasive Gynecol 2012;19:360-4.

Keogh SC, Fry K, Mbugua E, et al. Vocal local versus pharmacological treatments for pain management in tubal ligation procedures in rural Kenya: a non-inferiority trial. BMC Womens Health 2014;14:21.

Vitale SG, Alonso Pacheco L, Haimovich S, et al. Pain management for in-office hysteroscopy. A practical decalogue for the operator. J Gynecol Obstet Hum Reprod 2021;50:101976.

Oppegaard KS, Lieng M, Berg A, Istre O, Qvigstad E, Nesheim BI. A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial. BJOG 2010;117:53-61.

Al-Fozan H, Firwana B, Al Kadri H, Hassan S, Tulandi T. Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev 2015;4:CD005998.

Fouda UM, Gad Allah SH, Elshaer HS. Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study. Fertil Steril 2016;106:196-201.

De Silva PM, Wilson L, Carnegy A, Smith PP, Clark TJ. Cervical dilatation and preparation prior to outpatient hysteroscopy: a systematic review and meta-analysis. BJOG 2021;128:1112-23.

Karakus S, Akkar OB, Yildiz C, Yenicesu GI, Cetin M, Cetin A. Comparison of effectiveness of laminaria versus vaginal misoprostol for cervical preparation before operative hysteroscopy in women of reproductive age: a prospective randomized trial. J Minim Invasive Gynecol 2016;23:46-52.

Haggag HM, Hassan AM. The impact of altering filling pressures in diagnostic outpatient hysteroscopy on the procedure completion rates and associated pain: a randomised double-blind controlled trial. Aust N Z J Obstet Gynaecol 2016;56:97-101.

De Silva PM, Stevenson H, Smith PP, Justin Clark T. A systematic review of the effect of type, pressure, and temperature of the distension medium on pain during office hysteroscopy. J Minim Invasive Gynecol 2021;28:1148-59.e2.

Craciunas L, Sajid MS, Howell R. Carbon dioxide versus normal saline as distension medium for diagnostic hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2013;100:1709-14.e1-4.

Abdallah KS, Gadalla MA, Breijer M, Mol BWJ. Uterine distension media for outpatient hysteroscopy. Cochrane Database Syst Rev 2021;11:CD006604.

Evangelista A, Oliveira MA, Crispi CP, Lamblet MF, Raymundo TS, Santos LC. Diagnostic hysteroscopy using liquid distention medium: comparison of pain with warmed saline solution vs room-temperature saline solution. J Minim Invasive Gynecol 2011;18:104-7.

Sharma S, Roy KK, Rai R, Zangmo R, Malhotra N, Das A. Assessment of pain at different steps of diagnostic hysteroscopy using room temperature normal saline versus warmed normal saline solution as distension medium: a randomized controlled trial. Gynecol Minim Invasive Ther 2022;11:41-6.

Kühlmann AYR, de Rooij A, Kroese LF, van Dijk M, Hunink MGM, Jeekel J. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg 2018;105:773-83.

Tola YO, Chow KM, Liang W. Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: a systematic review. J Clin Nurs 2021;30:3369-84.

Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J 2008;87:780-807.

Santiváñez-Acosta R, Tapia-López ELN, Santero M. Music therapy in pain and anxiety management during labor: a systematic review and meta-analysis. Medicina (Kaunas) 2020;56:526.

Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev 2018;3:CD009514.

Mumm JN, Eismann L, Rodler S, et al. listening to music during outpatient cystoscopy reduces pain and anxiety and increases satisfaction: results from a prospective randomized study. Urol Int 2021;105:792-8.

El Boghdady M, Ewalds-Kvist BM. The influence of music on the surgical task performance: a systematic review. Int J Surg 2020;73:101-12.

Angioli R, De Cicco Nardone C, Plotti F, et al. Use of music to reduce anxiety during office hysteroscopy: prospective randomized trial. J Minim Invasive Gynecol 2014;21:454-9.

Law HY, Ng DYT, Chung CD. Use of music in reducing pain during outpatient hysteroscopy: Prospective randomized trial. J Obstet Gynaecol Res 2021;47:904-12.

Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open 2022;12:e051073.

Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev 2009;2:CD007214.

Santana LS, Gallo RB, Ferreira CH, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother 2016;62:29-34.

Arik MI, Kiloatar H, Aslan B, Icelli M. The effect of TENS for pain relief in women with primary dysmenorrhea: a systematic review and meta-analysis. Explore (NY) 2022;18:108-13.

Elboim-Gabyzon M, Kalichman L. Transcutaneous electrical nerve stimulation (TENS) for primary dysmenorrhea: an overview. Int J Womens Health 2020;12:1-10.

Lisón JF, Amer-Cuenca JJ, Piquer-Martí S, Benavent-Caballer V, Biviá-Roig G, Marín-Buck A. Transcutaneous nerve stimulation for pain relief during office hysteroscopy: a randomized controlled trial. Obstet Gynecol 2017;129:363-70.

De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for office hysteroscopy: a systematic review and meta-analysis. J Minim Invasive Gynecol 2020;27:1034-47.

Maarouf H, Marchand GJ, Ware K, et al. Systematic review of the safety and efficacy of tramadol during office hysteroscopy. Turk J Obstet Gynecol 2021;18:151-8.

Hassan A, Wahba A, Haggag H. Tramadol versus Celecoxib for reducing pain associated with outpatient hysteroscopy: a randomized double-blind placebo-controlled trial. Hum Reprod 2016;31:60-6.

De Silva PM, Carnegy A, Smith PP, Clark TJ. Local anaesthesia for office hysteroscopy: a systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020;252:70-81.

Zilbert A. Topical anesthesia for minor gynecological procedures: a review. Obstet Gynecol Surv 2002;57:171-8.

Lopez LM, Bernholc A, Zeng Y, et al. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev 2015;7:CD007373.

Luangtangvarodom W, Pongrojpaw D, Chanthasenanont A, Pattaraarchachai J, Bhamarapravatana K, Suwannarurk K. The efficacy of lidocaine spray in pain relief during outpatient-based endometrial sampling: a randomized placebo-controlled trial. Pain Res Treat 2018;2018:1238627.

Cooper NA, Khan KS, Clark TJ. Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. BMJ 2010;340:c1130.

Moving the Novasure procedure to an outpatient setting. A guide to paracervical and intrauterine fundal block. Available from: https://www.bsge.org.uk/wp-content/uploads/2021/06/NovaSure-LA-Protocol-Booklet.pdf.

Skensved H. Global-local anaesthesia: combining paracervical block with intramyometrial prilocaine in the fundus significantly reduces patients’ perception of pain during radio-frequency endometrial ablation (Novasure®) in an office setting. Gynecol Surg 2012;9:207-12.

Kumar V, Tryposkiadis K, Gupta JK. Hysteroscopic local anesthetic intrauterine cornual block in office endometrial ablation: a randomized controlled trial. Fertil Steril 2016;105:474-80.e1.

Reinders IMA, Geomini PMAJ, Leemans JC, et al. Intrauterine fundal anaesthesia during endometrial ablation in the office: A randomised double-blind, non-inferiority trial. Eur J Obstet Gynecol Reprod Biol 2020;254:206-11.

Skensved H. Combining paracervical block with a complete fundal block significantly reduces patients’ perception of pain during radio-frequency endometrial ablation in an office setting. J Minim Invasive Gynecol 2015;22:S45.

Campbell I. Uterine physiology. Anaesth Intensive Care Med 2005;6:76.

O’Neill A, Lirk P. Multimodal Analgesia. Anesthesiol Clin 2022;40:455-68.

Carugno J, Grimbizis G, Franchini M, et al. International consensus statement for recommended terminology describing hysteroscopic procedures. J Minim Invasive Gynecol 2022;29:385-91.

De Silva PM, Carnegy A, Smith PP, Clark TJ. Vaginoscopy for office hysteroscopy: a systematic review and metaanalysis. Eur J Obstet Gynecol Reprod Biol 2020;252:278-85.

Smith PP, Kolhe S, O’Connor S, Clark TJ. Vaginoscopy against standard treatment: a randomised controlled trial. BJOG 2019;126:891-9.

Di Spiezio Sardo A, Giampaolino P, Manzi A, et al. The invisible external cervical os. tips and tricks to overcome this challenge during in-office hysteroscopy. J Minim Invasive Gynecol 2021;28:172-3.

Noventa M, Ancona E, Quaranta M, et al. Intrauterine morcellator devices: the icon of hysteroscopic future or merely a marketing image? a systematic review regarding safety, efficacy, advantages, and contraindications. Reprod Sci 2015;22:1289-96.

De Silva PM, Stevenson H, Smith PP, Clark TJ. Pain and operative technologies used in office hysteroscopy: a systematic review of randomized controlled trials. J Minim Invasive Gynecol 2021;28:1699-711.

Dealberti D, Riboni F, Prigione S, Pisani C, Rovetta E, Montella F, Garuti G. New mini-resectoscope: analysis of preliminary quality results in outpatient hysteroscopic polypectomy. Arch Gynecol Obstet 2013;288:349-53.

Smith PP, Middleton LJ, Connor M, Clark TJ. Hysteroscopic morcellation compared with electrical resection of endometrial polyps: a randomized controlled trial. Obstet Gynecol 2014;123:745-51.

Pampalona JR, Bastos MD, Moreno GM, et al. A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results. J Minim Invasive Gynecol 2015;22:439-45.

Li C, Dai Z, Gong Y, Xie B, Wang B. A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions. Int J Gynaecol Obstet 2017;136:6-12.

Hysteroscopy action: campaign against painful hysteroscopy. Available from: https://www.hysteroscopyaction.org.uk/.

Harrison R, Kuteesa W, Kapila A, et al. Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy. Br J Anaesth 2020;125:e468-e470.

Downloads

Published

2023-04-06

How to Cite

1.
LAW JYP. Pain relief in hysteroscopy. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Nov. 23];23(1). Available from: https://hkjgom.org/home/article/view/331

Issue

Section

Perspective