Role of Oral Tramadol 50 mg in Reducing Pain During Colposcopy-Directed Cervical Biopsy: A Randomized Controlled Trial

Abstract

Objective The aim of the study was to assess safety and efficacy of 50-mg tramadol in reducing patient-perceived pain during colposcopy. Material and Methods We conducted a randomized double-blind placebo-controlled trial in the colposcopy unit of a tertiary referral hospital, Cairo, Egypt, from April 2018 to October 2018. Our primary outcome was pain during colposcopy-guided ectocervical punch biopsy. Our secondary outcomes were pain during speculum insertion, acetic acid application, Lugol iodine application, endocervical curettage (ECC), endocervical brushing, 10-minute postprocedure, and additional analgesia requirement. Pain was assessed using 10-cm visual analog scale. Results One hundred fifty women were randomized into 2 groups: tramadol group (n = 75) received oral 50-mg tramadol tablets, and control group (n = 75) received placebo tablets. Both groups showed no significant difference in anticipated pain score (p = .56), pain scores during speculum insertion (p = .70), application of acetic acid (p = .40), and Lugol iodine (p = .79). However, the mean pain scores were significantly lower in tramadol group compared with placebo at ectocervical biopsy (p = .001), ECC (p = .001), endocervical brushing (p = .001), and 10 minutes after colposcopy (p = .001). Need for additional analgesia was significantly lower in tramadol group (p = .03). Conclusions Oral tramadol 50 mg significantly reduces pain perception during colposcopy-guided ectocervical biopsy, ECC, endocervical brushing, and 10 minutes after colposcopy with tolerable adverse effects.

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

“…Music and forced cough during biopsy are simple strategies that have shown to be effective in reducing pain and anxiety at the time of the colposcopy exam [ 24 , 25 , 26 , 27 , 28 ]. Data on oral analgesia (NSAIDs, opioids) prior to or after the colposcopy exam are lacking and mixed [ 29 , 30 ]; however, these may be considered in addition to non-pharmacologic techniques.…”

Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa

“…Relevant research had demonstrated that tramadol, rather than other more powerful opioid medications, can also have some desirable postoperative analgesic effects but with fewer side effects. [102][103][104] The Royal College of Anesthetists claims that 67 mg of tramadol offers the same analgesic effective as 10 mg of morphine. 105 Consequently, tramadol is often utilized in low-and middle-income nations.…”

The Efficacy of Oral Etoricoxib in Pain Control During Colposcopy-Directed Cervical Biopsy: A Randomized Control Trial

“…Colposcopy is a standard procedure following abnormal cervical cancer screening. All steps of procedure especially colposcopic directed biopsy (CDB) and endocervical curettage (ECC) made pelvic discomfort, pelvic pain, and anxiety (Darweesh et al, 2020;Wittenborn et al, 2022).…”

“…The Efficacy of Oral Etoricoxib in Pain Control During Colposcopy-Directed Cervical Biopsy: A Randomized Control Trial prilocaine intracervical injection (Kiviharju et al, 2017) and oral analgesic drugs ibuprofen (Church et al, 2001) and tramadol (Darweesh et al, 2020). The outcomes of pharmacological methods varied in effectiveness to reduce pain during and after colposcopy.…”

“…Systematic reviews reported that local cervical anesthesia administration has no statistically significant outcomes in pelvic pain reduction during colposcopy (Mattar et al, 2019). Whereas some oral analgesias were found to significantly decrease pain (Darweesh et al, 2020). So, low-potency oral analgesia should be offered for pain reduction, while high-potency analgesias such as meperidine or morphine may not be recommended.…”