Pain Clinical Trial
Official title:
Pain Relief During Unsedated Office Hysteroscopy by Applying Transcutaneous Electrical Nerve Stimulation : Randomized Controlled Trial
Pain Relief During Unsedated Office Hysteroscopy by Applying Transcutaneous Electrical Nerve Stimulation : Randomized controlled trial
Patients fulfilling inclusion criteria will be distributed in two groups, each one will be
(60) patients (more than sample size number) to avoid the drop in the size of the study.
Group (A):(60) Active TENS during office hysteroscopy. Group (B)(60) placebo TENS during
office hysteroscopy. The active TENS intervention consisted of a varying high-frequency
(80-100 Hz), pulse duration 400-microseconds.Transcutaneous electrical nerve stimulation
therapy will be initiated 5 minutes before starting the hysteroscopy and for the duration of
the procedure. Two sets of two self-adhesive electrodes (circular pads) will be placed
parallel to the spinal cord at the T10-L1 and S2-S4 levels .
Group (A)(60) Active TENs during office hysteroscopy The device intensity (amplitude) will be
individually adjusted to each participant's maximum sensory level (strongest reported
tingling feeling without pain and with no muscle contractions. Patients will be informed
about the importance of maintaining the stimulation at a maximum non painful level. Thus, the
TENS output intensity will be increased during the treatment every time the patient
accommodated to the TENS stimulus. All the hysteroscopies will be performed by the same
experienced consultant in (ECDU), who will be blinded to the patients' group allocations.
Uterine cavity will be distended with normal saline
Group (B):(60) placebo TENs during office hysteroscopy To achieve blinding in the placebo
group, participants will be connected to the TENS unit in exactly the same way as
participants in the active TENS group with the unit emitting the active indicator light and
sound but delivering no electrical stimulation.
Primary Outcome Measures :
The level of pain at the end of office hysteroscopy procedure (primary outcome) will be
measured 5 minutes after procedure on a 100-mm-long horizontal line visual analog scale (VAS;
0 mm=no pain and 100 mm=worst possible pain).
A discrete, 5-point, verbal Likert scale including the following options: "no pain," "minimal
pain," "moderate pain," "severe pain," and "worst pain possible," will be used to assess the
internal consistency of the pain rating 5 minutes after procedure.
Secondary Outcome Measures The pain of hysteroscopy entry, contact, and biopsy. The duration
of the procedure, vital parameters (blood pressure, heart rate, arterial oxygen saturation),
vasovagal symptoms (dizzin ess, nausea, vomiting, shoulder pain, vertigo, sweating, or
fainting), and unusual or adverse TENS events (skin allergy, pain, or burning at the
electrode site) will be recorded during all the hysteroscopy procedures.
Finally, the level of satisfaction with the hysteroscopy, as indicated on a scale of ( 0-10),
was measured at the end of the procedure .
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