The Effect of Forced Cough to Minimize Pain and Discomfort at the Time of Colposcopy-Guided Cervical Biopsy

Abstract

Objective The aim of the study was to determine whether forced cough during colposcopy-guided cervical biopsy affected pain and anxiety levels. Materials and Methods The study was conducted at the University Hospital (Newark, NJ) Ambulatory Care Center from December 2016 to June 2018 and evaluated 110 patients at the time of a colposcopy-guided cervical biopsy. Study patients were randomized to either cough or no cough group during the biopsy procedure. Pain level was assessed using a visual analog pain scale before, during, and immediately after a colposcopy-guided cervical biopsy. Study patients also completed a standardized anxiety survey before and after the procedure. T tests, Pearson χ2, or Cochran-Mantel-Haenszel were used to compare baseline characteristics between the cough and no cough groups. Multivariate linear regression analysis was used to identify potential confounders and then compare pain levels across both groups. Results There was no statistically significant difference in pain scores between the cough and no cough group when analyzed for each demographic variable even when confounders were accounted for. The anxiety scores for both study groups before and after the procedure were similar and not significantly reduced. Conclusions We observed a trend that cough reduced pain associated with the colposcopy-guided cervical biopsy but did not reach statistical significance. A similar outcome was observed in anxiety level, where anxiety was reduced in the cough group but was not statistically significant as compared with the no cough group. Further studies are necessary to assess various modalities in reducing pain and anxiety associated with colposcopy-guided cervical biopsy.

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

“…Other non-pharmacologic techniques that have been suggested include: relaxation, guided imagery, distraction and having a support person present [ 23 ]. 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.…”

Is Forced Coughing Effective in Reducing Pain During Cervical Biopsy?

“… 18 The literature has reported no adverse effects or reactions and no additional costs in the FC group. 2 , 5 , 16 – 19 Conversely, injecting an LA might cause tissue damage that will interfere with the pathological diagnosis. 16 …”

“…18 The literature has reported no adverse effects or reactions and no additional costs in the FC group. 2,5,[16][17][18][19] Conversely, injecting an LA might cause tissue damage that will interfere with the pathological diagnosis. 16 Pain is a highly subjective, complex phenomenon, and its perception can be influenced by several factors such as race/ethnicity, gender, previous experience, number of vaginal births and psychological state.…”