Pain Control Methods in In-Office Gynecologic Procedures: A Critique

Date of Award

Spring 2023

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Kimberly Erikson, MMS, PA-C

Abstract

Gynecologic procedures commonly done in-office such as colposcopy with cervical biopsy, hysteroscopy, intrauterine device (IUD) insertion, and endometrial biopsy are routine and essential to female health care. Often, patients are anxious and hesitant about getting these procedures after learning about the pain associated with them. This can prevent them from receiving needed care or prevent completion of a successful procedure. For these reasons, pain control for these procedures is important, although there is no consensus in the literature on what is effective or best practice. There is a limited amount of recent studies done on pain control for these procedures, and those that exist involve varying methods of design, outcome, and patient population. Recently published systematic reviews still cite evidence from decades prior, and use it to support current conclusions. This is illustrated in the evidence described below. Based on current research, the best methods for pain control are topical and local anesthesia for cervical pain, and para or intracervical blocks and intrauterine anesthesia for additional uterine pain. It is clear that there are many variables that play a role in pain perception during and after these procedures, which may play a role in ambiguity in the literature.

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Pain Control Methods in In-Office Gynecologic Procedures: A Critique

Gynecologic procedures commonly done in-office such as colposcopy with cervical biopsy, hysteroscopy, intrauterine device (IUD) insertion, and endometrial biopsy are routine and essential to female health care. Often, patients are anxious and hesitant about getting these procedures after learning about the pain associated with them. This can prevent them from receiving needed care or prevent completion of a successful procedure. For these reasons, pain control for these procedures is important, although there is no consensus in the literature on what is effective or best practice. There is a limited amount of recent studies done on pain control for these procedures, and those that exist involve varying methods of design, outcome, and patient population. Recently published systematic reviews still cite evidence from decades prior, and use it to support current conclusions. This is illustrated in the evidence described below. Based on current research, the best methods for pain control are topical and local anesthesia for cervical pain, and para or intracervical blocks and intrauterine anesthesia for additional uterine pain. It is clear that there are many variables that play a role in pain perception during and after these procedures, which may play a role in ambiguity in the literature.