Pharmacological and non-pharmacological pain relief for office hysteroscopy: an up-to-date review

Abstract

In-office hysteroscopy is considered the standard technique for visualization of the uterine cavity and the diagnosis of intrauterine pathologies. Moreover, nowadays, it is possible to treat a vast number of intracavitary diseases in the office, without the need for the inpatient setting. However, in some cases, pain might occur, and this is the most common reason for not completing the procedure. Over the last 20 years, many efforts have been carried out to miniaturize the instrumentation and to improve the techniques in order to avoid discomfort. Nonetheless, hysteroscopy still provokes distress for many patients. For this reason, pharmacological and non-pharmacological treatments for intraoperative and postoperative pain relief have been widely used for in-office hysteroscopy, with different results in various groups of women. The purpose of this review was to analyze the current literature on pharmacological aids (non-steroidal anti inflammatory drugs, cyclooxygenase-2 inhibitors, antispasmodics, local anesthetics, prostaglandins, opioids) and non-pharmacological interventions (transcutaneous electrical nerve stimulation, uterine stretching, uterine pressure, warming of distension medium, hypnosis, music, vocal–local) and to evaluate their impact on the relief from pain experienced during in-office hysteroscopy.

摘要

门诊宫腔镜是观察宫腔和诊断宫内病变的标准技术。此外, 现在通过门诊宫腔镜治疗大量宫内疾病已成为可能而无需住院。但是, 某些情况下, 可能发生疼痛, 这是无法完成操作最常见的原因。最近20年, 为了减少不适感在缩小仪器和改进技术方面做了许多努力。尽管如此, 宫腔镜仍给许多患者带来痛苦。因此, 用于术中和术后镇痛的药物治疗和非药物治疗被广泛应用于门诊宫腔镜检查, 在不同的妇女群体中效果不同。本篇综述旨在对目前关于药物辅助 (非甾体抗炎药、环氧化酶-2抑制剂、解痉药、局麻药、前列腺素、阿片类药物)和非药物干预(经皮神经电刺激、子宫平滑肌舒张、子宫加压、灌流液升温、催眠、音乐、心语疏通)的文献进行分析, 并评价其对门诊宫腔镜疼痛缓解的影响。

Keywords:

• In-office hysteroscopy
• pain management
• pharmacological treatment
• non-pharmacological treatment

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

None.