Impact of preprocedural anxiety levels on pain perception in patients undergoing office hysteroscopy

Abstract

Background: We aimed to determine if preprocedural anxiety levels had a significant association with procedure-related pain in women undergoing office hysteroscopy (OH) and also to assess the effect of various clinical factors on pain perception in these women.

Methods: There were 148 women undergoing OH enrolled in this observational study. Before examination, patients were asked to complete two forms, the STAI-T (State-Trait Anxiety Inventory, Trait) and STAI-S (State-Trait Anxiety Inventory, State) anxiety scales, to evaluate their usual anxiety state and state of anxiety during the examination. Patients were asked to quantify on a visual analog scale the pain felt during and 60 minutes after the procedure. Associations between STAI and visual analog scale scores were assessed using correlation analysis. The effects of various contributing factors on pain perception were investigated with linear regression analysis. A p value < 0.05 was considered statistically significant.

Results: The preprocedural mean trait and state anxiety scores were 38.4 ± 9.2 and 44.8 ± 10.0, respectively, and the mean patient age was 43.6 ± 3.3 years. During OH, there were significant positive correlations between in-hospital waiting time, procedure time, preprocedural trait or state anxiety scores, and pain. Sixty minutes after OH, significant positive correlations between in-hospital waiting time, procedure time, preprocedural state or trait anxiety scores, and pain were observed. There was also a significant negative correlation between parity and procedure-related pain 60 minutes after procedure. OH-related pain scores during the procedure were significantly affected by in-hospital waiting time (p < 0.001), state anxiety level (p = 0.001), and trait anxiety level (p = 0.01). However, 60 minutes after the procedure, pain was affected by patient parity (p = 0.02), procedure time (p = 0.002), and preprocedural state anxiety level (p < 0.001).

Conclusion: The pain that study participants felt during and soon after OH was negatively affected by preprocedural anxiety levels. Some factors, such as reducing the waiting time before the procedure, might be useful in reducing anxiety levels.

Keywords: anxiety; office hysteroscopy; pain perception.