Injection of 1% lidocaine has been shown to reduce procedure-related pain perceived by patients in a number of studies, but the injection is painful and accessing the site for analgesia can be difficult. Moreover, the needle may produce tissue damage that can interfere with the pathological diagnosis, and accidental intravascular injection can lead to unwanted side effects. A number of nonpharmacologic techniques have been investigated as alternatives to local anesthesia. These include counter stimulation, pressure, hypnosis, and distraction. The most effective of these appears to be distraction, which in several reports has been shown to provide effective pain relief during injections, dressing changes in burn patients, and other pain causing procedures. This randomized trial compared the effectiveness of pain relief achieved by forced coughing at the moment of colposcopically-directed biopsy with that produced by administration of a local 1% lidocaine injection. Between 2006 and 2007, 68 patients with abnormal Papanicolaou smears undergoing colposcopically-directed cervical punch biopsy were randomized to either a forced coughing group (n = 34) or to a local anesthesia group (n = 34). Patients in the forced coughing group were told to cough at the moment of biopsy. Patients in the local anesthesia group were injected with 0.5 mL of 1% lidocaine using a 27-gauge needle. A 10-cm visual analog scale was used to measure pain immediately after the cervical biopsy. The time needed to perform the procedure was also measured.
There was no difference in visual analogue median pain scores between the local anesthetic and forced coughing groups (1.5 cm vs. 1.9 cm, with a 95% confidence interval [CI] of -0.4-1.3 cm) (P = 0.47). Compared with forced coughing, local anesthesia prolonged the procedure by a median of 2.11 minute (95% CI, 1.6-2.8; P < 0.001).
These findings suggest that forced coughing is as effective as local anesthesia in reducing patient pain associated with colposcopically directed cervical biopsies and significantly reduces examination time.