Effect of Pre-procedure Anxiety Levels on Post-procedure Pain Scores in Women Undergoing Hysterosalpingography in South-south Nigeria

Abstract


 Background: Infertility is the inability of a couple to conceive after one year of regular, unprotected sexual intercourse. Hysterosalpingography plays a very crucial role the evaluation of the women with infertility.
 Objective: To determine the relationship between pre-procedure anxiety and procedure-associated pain among infertile women undergoing hysterosalpingography.
 Materials and Methods: This prospective survey was conducted at the Obstetrics and Gynaecology, and Radiology Departments of the two tertiary health institutions in Bayelsa State, Nigeria, from January to August, 2021. Hysterosalpingography was done for 380 infertile women, after obtaining written informed consent. Beck's Anxiety Inventory (BAI) and Numerical Rating Scale (NRS) were used to grade levels of anxiety and pain, respectively. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions (SPSS) version 25.0. Results were presented in frequencies and percentages for categorical variables; mean and standard deviation for continuous variables.
 Results: The pre-procedure anxiety scores showed significant, positive, and strong relationship with post-procedure pain scores, reflected in a correlation coefficient of 0.50 (p – 0.001). For every unit change in anxiety score, there was an estimated 25.4% change in the pain perception documented by the participants. For participants who had an anxiety score of 0, there was an average pain score of 3.45.
 Conclusion: This study established a positive correlation between pre-hysterosalpingography anxiety scores and post-hysterosalpingography pain scores.

The Consequences of Preprocedural Anxiety Level on Post Procedural Pain in Women Experienced During Hysterosalpingography

“…This activation relays a neural signal through the hypothalamus to stimulate the release of preganglionic acetylcholine, which is a neurotransmitter. Acetylcholine, in turn stimulates the release of epinephrine and norepinephrine, which are catecholamine from the adrenal cortex [7][8][9] .…”

“…A study conducted by Kiridi KE [7] revealed that there was a significant, positive, and strong relationship between pre-procedure anxiety and post-procedure pain. This is in keeping with the report from the study of Tokmak et al [14] where there was significant positive correlation between the level of pre-procedure anxiety and the level of post-Hysterosalpingography pain perception.…”

Effectiveness of paracervical block for pain relief in women undergoing hysterosalpingography in Bayelsa State, South-South Nigeria: a randomized control trial

“…Anxiety and stress can enhance the procedure-associated pain of hysterosalpingography. 8 Two pain score scales were used in this research. The VAS was used to score the level of pain that the women expressed at different steps of this investigative modality, while the numerical rating scale (NRS) was used to score the overall pain perception at the end of the procedure.…”

“…However, one of the major shortcomings of hysterosalpingography is discomfort and/or pain for the patient during or after the investigative modality; and this is a major cause of anxiety for many patients. 8 Patients feel pain at various points during hysterosalpingography. In our practice, individual patients may feel pain during the insertion of speculum, grasping the lip of the cervix with a tenaculum, insertion of the canula or injection of contrast media into the uterine cavity.…”

Effect of addition of antispasmodic to local and systemic analgesics on pain perception during hysterosalpingography: a randomized controlled trial

“…It causes a lot of stress and anxiety for the couple involved. 1 About 17% of couples worldwide, are affected by infertility. It is defined as the inability to conceive after 12 months of adequate and regular unprotected, peno-vaginal, ejaculatory sexual intercourse.…”