title: Identifying predictors of unacceptable pain at office hysteroscopy.
abstract: OBJECTIVE
  To identify predictors of unacceptable pain during office hysteroscopy without anesthesia.
  
  
  METHODS
  Prospective observational study (Canadian Task Force classification II-2).
  
  
  METHODS
  Teaching hospital.
  
  
  METHODS
  Five hundred fifty-eight women aged 17 to 73 years.
  
  
  METHODS
  Elective office hysteroscopy without anesthesia.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil. Electronic address: marlon@iff.fiocruz.br.
authors.forename: Márlon
authors.initials: M
authors.lastname: de Freitas Fonseca
authors.affiliation: Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil.
authors.forename: Felipe V
authors.initials: FV
authors.lastname: Sessa
authors.affiliation: Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil; Department of Urology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil.
authors.forename: José Anacleto D
authors.initials: JA
authors.lastname: Resende
authors.affiliation: Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil.
authors.forename: Camilla Gabriely S
authors.initials: CG
authors.lastname: Guerra
authors.affiliation: Department of Gynecology, Centro de Video-Endoscopia, Rio de Janeiro, Brazil.
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Andrade
authors.affiliation: Department of Gynecology, Centro de Video-Endoscopia, Rio de Janeiro, Brazil.
authors.forename: Claudio P
authors.initials: CP
authors.lastname: Crispi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D002170:Canada; D004412:Dysmenorrhea; D004414:Dyspareunia; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Confounding; Diagnostic hysteroscopy; Menstrual cramps; Predictors of pain; Preemptive analgesia