Multimodal Pain Management Strategies for in Office Cervical Biopsy in Women with Recurrent Cervicitis

Abstract

Objective: To compare the effectiveness of multimodal analgesia with single-modality and standard care in reducing pain and anxiety and improving patient satisfaction among women undergoing colposcopy-directed cervical biopsy.

Methodology: A randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Chitral Scouts Hospital, from October 2023 to July 2024. A total of 370 women aged 18–50 years with recurrent cervicitis were randomized into three groups: Control (standard care, n = 123), Single-modality (local infiltration with 2% lidocaine, n = 123), and Multimodal (oral etoricoxib 120 mg one hour before procedure + local lidocaine infiltration + non-pharmacological support including forced cough and verbal reassurance, n = 124). Pain intensity was assessed using a Visual Analogue Scale (VAS, 0–10) before, during, and 15 minutes after biopsy. Anxiety was measured using the State-Trait Anxiety Inventory (STAI), and satisfaction was rated on a 5-point Likert scale. Data were analyzed using SPSS version 26.0, with ANOVA and Chi-square tests; p < 0.05 was considered significant.

Results: Baseline characteristics were comparable among groups (p > 0.05). Intra-procedural pain scores were significantly lower in the Multimodal group (2.3 ± 0.9) than in Single-modality (4.5 ± 1.2) and Control groups (6.8 ± 1.4) (p < 0.001). Post-procedure pain showed a similar pattern (1.5 ± 0.7 vs. 2.9 ± 0.8 and 4.1 ± 1.0, p < 0.001). The Multimodal group also reported lower anxiety scores (34.2 ± 6.5, p = 0.004), higher satisfaction (91.9%, p < 0.001), and greater willingness for repeat biopsy (87.9%, p < 0.001). Mild adverse effects were comparable across groups (p = 0.65).

Conclusion: Multimodal analgesia significantly reduced pain and anxiety while improving satisfaction without increasing side effects. It is a safe and effective approach for outpatient cervical biopsies in women with recurrent cervicitis.