Variables affecting immediate pain tolerance in X-ray hysterosalpingography

Document Type





Objective: To determine the variables, which affect pain tolerance in x-ray hysterosalpingography (HSG).
Design: Cross-sectional comparative study.
Place and duration of study: Radiology departments of Civil and Bismillah Taqee Hospitals and Delhi Mercantile Medical Centre, Karachi from January 1999 to June 2003.
Patients and methods: The study included 250 patients who underwent x-ray HSG using small sized Leech Wilkinson cannula by the same radiologist. Informed verbal consent was obtained from all the patients. Pain was graded into tolerable and intolerable using a four-point visual analog scale (VAS) as well as the Pakistani coin scale after pre-medication with diclofenac (generic name). Standard procedures using day-light fluoroscopy was performed. Variables considered were age, indication of the procedure, type of infertility, whether primary or secondary, emotional state, motivation for investigation, presence or absence of cystocele, duration of procedure, type of contrast used, whether ionic or non-ionic, tubal patency and lastly the amount of contrast used in the procedure. Those patients having infection, cervical erosion, use of larger size of cannula and technical complications including excessive bleeding requiring the use of sanitary napkins and vascular intravasation were excluded. The obtained data was analyzed on SPSS version 10.0 using cross tabulation and Pearson's correlation coefficient. Significance was taken at p<0.05.
Results: The mean age of the patients was 30 years. Amenorrhea, secondary infertility, apprehension, prolonged procedure time (>15 minutes) and the use of ionic contrast media were the variables significantly associated with intolerable pain during the procedure. Primary infertility, calm emotional state, self-motivation, absence of cystocele and short procedure duration were associated with good pain tolerance. The amount of contrast used and tubal patency status had no significant association.
Conclusion: In the setting of base line pre-medication with diclofenac and minimal cervical trauma, amenorrhea, primary infertility, emotional state, self-motivation, procedure duration, and the presence or absence of cystocele significantly affect pain tolerance during the procedure. Amount of contrast used and tubal patency does not affect pain tolerance. Effect of the type of contrast medium requires further confirmation on a larger number of patients.

Publication (Name of Journal)

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP