Outpatient Hysteroscopy is a Painful Procedure

I am a senior research fellow in the Centre of Integrative Neuroscience & Neurodynamics (CINN) at the University of Reading and joint lead of the CINN Pain Lab. I am primarily interested in the individual differences that underlie pain, and in particular, understanding why some people appear to be resilient to pain, while others are vulnerable. My PhD focused on neuroscientific mechanisms of pain perception, including the influence of mindfulness and descending pain modulation. Over the past 4 years, I have been working closely with clinicians at the Royal Berkshire Hospital to apply this experimental research to the domains of pain management, gynaecology and radiology. The primary focus of my talk will be my 2020 British Journal of Anaesthesia publication (detailed below; doi.org/10.1016/j.bja.2020.08.015), as well as future directions for preclinical assessment.

Hysteroscopy is a gynaecological procedure used to inspect for pathological conditions in the uterine cavity. Multiple sources in the UK describe this procedure as non-painful, although this description is being challenged by public campaigns. We evaluated surgical data from 801 hysteroscopy patients, primarily focussing on patient’s retrospective ratings of intraoperative pain. We also compared these ratings to the clinician’s estimates of patient pain, and to the dosage of anaesthetic applied. It was found that hysteroscopy is associated with a range of pain intensities (Mrating= 3.97, s.d. =2.45), with only a small subset of patients (7.8%) experiencing no pain at all. Patients who received the highest dose of analgesia described the most pain. However, clinicians viewed these patients as being in the least pain, potentially indicating an overestimation of the efficacy of the analgesia. Our findings indicate that severe pain is a genuine risk within hysteroscopy.