Identifying Predictors of Unacceptable Pain at Office Hysteroscopy

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. (C) 2014 AAGL. All rights reserved.