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Pain Perception in Cervical Biopsy- Variations by Patient and Provider Characteristics in an Academic Teaching Clinic

Purpose: We aim to identify factors which dependably predict patients’ experience of pain during colposcopy, and to evaluate if providers, stratified by level of training, are capable of anticipating procedural pain.

Background: Cervical biopsy procedures, including colposcopy and loop electrosurgical excision procedure (LEEP), are considered non-invasive office procedures and efforts to codify their use emphasize logistics and ability to detect disease. A significant gap exists for mitigating psychological distress and procedural pain. Previous research suggests that physician assessment of procedural discomfort varies by years of experience.

Methods: Patients presenting to an academic gynecology practice for colposcopy with cervical biopsy or LEEP completed Pre- and Post-Procedure surveys (14- and 3-item surveys, respectively), assessing demographics, past cervical procedures, menstrual pain, and anticipated biopsy pain, among other metrics. Post-Procedure surveys assessed a numerical level of pain experienced during the biopsy. The health care provider (HCP) and procedural assistant were surveyed for perceptions of patient pain. Pain scores were evaluated using a 100mm visual analog scale.  Data analysis was performed using Spearman rank correlation, and coefficients for relevant variables were calculated.

Results: 80 patients were enrolled and 62 underwent cervical biopsy. Patients with higher anticipated pain gave higher ratings for post-procedure pain (p=0.024). Women reporting more intense periods predicted and experienced more procedural pain (p<0.001, p=0.058). From the provider perspective, HCPs correctly estimated patients’ pain when compared with the patients’ perceptions (p=0.066). However, only PGY3 and PGY4 OB/GYN residents did so with statistical significance (p=0.014) and PGY1 and PGY2 residents rated lower pain scores (p=0.039).  Male assistants rated pain lower than female assistants (p=0.037). 

Discussions: Providers accurately estimated patients’ pain with variation by years of training. Patient characteristics of age, anxiety, and dysmenorrhea were reliable predictors of pain levels. Our findings suggest that pre-procedure screening of patients may be helpful in directing pain reduction interventions. Additionally, years of experience may provide enhanced pain perception, suggesting future research into pain management training for junior resident physicians and medical students.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Practice-Based Learning & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,