Study objective: To identify predictors of unacceptable pain during office hysteroscopy without anesthesia.
Design: Prospective observational study (Canadian Task Force classification II-2).
Setting: Teaching hospital.
Patients: Five hundred fifty-eight women aged 17 to 73 years.
Intervention: Elective office hysteroscopy without anesthesia.
Measurements and main results: Pain intensity was assessed via a verbal rating scale (VRS, 0-10). Pain was considered unacceptable when severe during the procedure (VRS ≥7) or moderate to severe at discharge (VRS ≥4). After preliminary statistical analysis, factors including diabetes, age ≤50 years, previous curettage, dyspareunia, severe dysmenorrhea, and hysteroscopist experience were selected to compose 2 binary multivariate models to predict unacceptable pain. As expected, hysteroscopist experience was protective against unacceptable pain during office hysteroscopy (p = .03; adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 41-96) and also at discharge (p = .002; adjusted OR, 0.48; 95% CI, 30-77). Severe dysmenorrhea was a significant risk factor for pain (cramps) at discharge (p < .001; adjusted OR, 3.07; 95% CI, 1.97-4.78).
Conclusion: Women with severe dysmenorrhea will benefit from preemptive analgesia regardless of hysteroscopist level of experience because this condition significantly increased the occurrence of unacceptable cramps at discharge.
Keywords: Confounding; Diagnostic hysteroscopy; Menstrual cramps; Predictors of pain; Preemptive analgesia.
Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.