Coughing at Time of Cervical Biopsy

Study Overview
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Brief Summary
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To investigate the effect of coughing as an intervention to reduce pain in colposcopy guided biopsy.

Detailed Description
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Colposcopy is a frequently practiced examination and Colposcopy guided biopsy causes pain. A few trials Investigated whether medical interventions such as the application of lidocaine led to reduced pain perception with inconsistent results. Only one trial compared coughing versus no coughing at the moment of biopsy. Although the results of this study did not lead to a significant difference between the two study arms, coughing seems to positively affect pain perception. Since the patients are, in the best case, their own controls when it comes to subjective parameters such as pain perception, we prefer a cross-over rather than a parallel group design. Based on the descriptive variables for pain during biopsy with and without cough determined in the pilot study, a case estimate for a prospective randomized cross-over study will be carried out. Since two biopsies are usually taken from the cervix in daily practice, the now planned pilot study in a cross-over design envisages the following two study arms: Group I: Patients cough during the first biopsy, they do not cough during the second biopsy Group II: Patients cough during the second biopsy, they do not cough during the first biopsy The primary Outcome measure is the difference in the patients' perception of pain during the first and second biopsy on the cervix (ectocervix), measured using an 11-part numerical analogue scale (11-item NAS).

Official Title
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Pain Reduction by Forced Coughing During Colposcopy Guided Cervical Biopsies: a Randomized Controlled Pilot Study

Conditions
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Cervical Cancer, Cervical Dysplasia, Colposcopy, Pain Sensation, Cervical Biopsy

Intervention / Treatment
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* Behavioral: Coughing at the time of biopsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Completed 18 years of age written informed consent first colposcopy Clinically indicated colposcopy in case of an abnormal PAP smear or screening result and/or clinical abnormalities on the cervix uteri Necessity to take exactly two biopsies Exclusion Criteria: Performing only one biopsy or more than two biopsies Performing an endocervical curettage (biopsy on the endocervix) Vaginal bleeding at the time of examination inadequate colposcopy Cervix uteri cannot be fully visualized Pregnancy Patients with insufficient German language skills known anxiety disorders or depressive disorders Treatments already carried out on the cervix uteri Patients with a chronic or acute illness that influences the perception of pain or lead to permanent pain due to the disease itself psychosomatic illnesses Chronic use of pain medications or psychotropic medications or other medications that may have an influence on the sensation of pain

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Coughing at the time of first biopsy<br>Patients are asked to cough during the first biopsy. They should not cough during the second biopsy, and no additional interventions will be performed during the second biopsy. | Behavioral: Coughing at the time of biopsy<br>* Patients are asked to cough or not to cough during cervical biopsy.<br>|
| Active Comparator: Coughing at the time of second biopsy<br>Patients are asked to cough during the second biopsy. They should not cough during the first biopsy, and no additional interventions will be performed during the first biopsy. | Behavioral: Coughing at the time of biopsy<br>* Patients are asked to cough or not to cough during cervical biopsy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference in pain between first and second biopsy | the difference in the patients' perception of pain during the first and second biopsy on the cervix (ectocervix), measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately after the examination | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain perception before examination | the patients' perception of pain before examination, measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately before the start of the examination | 
| Pain perception when inserting the specula | the patients' perception of pain at the moment of the insertion of the specula, measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately after the insertion of the specula | 
| Pain perception when using acetic acid | the patients' perception of pain at the moment of the application of acetic acid, measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately after the application of acetic acid | 
| Pain perception at first biopsy | the patients' perception of pain during the first biopsy, measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately after the first biopsy was performed | 
| Pain perception at second biopsy | the patients' perception of pain during the second biopsy, measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately after the second biopsy was performed | 
| Pain perception just after examination | the patients' perception of pain just after finishing the examination, measured using an 11-part numerical analogue scale (11-item NAS). The numerical analogue scale consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (score 0) and 'pain as bad as it could be' (score 10). Women will be asked to mark her pain level on the line between the two endpoints. | Immediately after the removal of the specula | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pain, cervical cancer, cervical dysplasia, cervical biopsy, coughing, distraction