Factors associated with participant and provider pain rating during office-based first-trimester vacuum aspiration.

OBJECTIVE: The objective was to describe factors associated with reported pain and assess correlations between participant and provider pain assessments during first-trimester vacuum aspiration. STUDY DESIGN: Participants and providers in a trial evaluating music for pain reduction reported procedure-related pain using a 100-mm visual analog scale. RESULTS: The mean participant-reported maximum pain was 65.9±23.0 compared to 41.3±22.0 by provider assessment. Provider-reported scores correlated poorly with participant maximum pain (r=0.28) and participant maximum pain adjusted for baseline (r=0.27). Previous abortion (60.5 versus 71.4, p=.02) and immediate intrauterine device insertion (46.1 versus 68.6, p=.03) were associated with lower participant-reported pain. CONCLUSIONS: Providers underestimate pain reported during vacuum aspiration; provider estimates correlate poorly with participant self-report. IMPLICATIONS: To improve management of pain during first-trimester vacuum aspiration, we need to better understand factors that influence patient and provider pain rating. When assessing patient pain in this setting, providers should not assume a baseline of zero pain.

Uterine Sounding: Is There a Difference between Blind and Hysteroscopically Directed Measurements?

STUDY OBJECTIVE: To evaluate the accuracy of traditional blind uterine sounding in measuring uterine cavity length (UCL), compared with measurement by hysteroscopic guidance. DESIGN: A cross-sectional descriptive study (Canadian Task Force classification III). SETTING: Academic multispecialty medical center. PATIENTS: Fifty-eight women undergoing elective hysteroscopic procedures. INTERVENTION: UCL measurement. MEASUREMENTS: UCL measurements were obtained by the traditional blind sounding technique and by hysteroscopically directed measurement. Hysteroscopic measurements were assumed to represent true uterine cavity length. Differences between the 2 measurements were calculated to analyze error and bias. RESULTS: Mean UCL for blind sounding and hysteroscopically directed measurements were 80.81 mm and 86.55 mm, respectively. The magnitude of error between measurements was >10 mm in 36.2% of cases, with underestimation of true UCL in 55.17% of cases. CONCLUSION: True UCL is underestimated by blind sounding, and the frequency, magnitude, and direction of error may be greater than are clinically acceptable.

Music as an auxiliary analgesic during first trimester surgical abortion: a randomized controlled trial.

BACKGROUND: Music has served as an auxiliary analgesic in perioperative settings. This study evaluates the impact of intraoperative music added to routine pain control measures during first trimester surgical abortion. STUDY DESIGN: We analyzed data from 101 women randomized to undergo abortion with routine pain control measures only (ibuprofen and paracervical block) or with the addition of intraoperative music via headphones. The primary outcome was the change in preoperative and postoperative pain scores on a 100-mm visual analog scale. Secondary outcomes included change in anxiety and vital signs, and satisfaction. RESULTS: Baseline characteristics were similar between groups. The magnitude of increase in pain scores was greater in the intervention than in the control group (+51.0 mm versus +39.3 mm, p=.045). Overall pain control was rated as good or very good by 70% of the intervention and 75% of the control group (p=.65). CONCLUSIONS: Intraoperative music added to routine pain control measures increases pain reported during abortion.