Forced coughing reduces discomfort of cervical biopsy, but?

Forced coughing can reduce the discomfort of a cervical biopsy as much as local anesthesia can, but the method gives physicians much less time for examination, according to a report published in the December issue of the American Journal of Obstetrics & Gynecology.

Bernd C. Schmid, MD, of the Medical University of Vienna in Vienna, Austria, and colleagues conducted a study of 68 women who underwent cervical punch biopsy. The women were randomized to use forced coughing as a form of pain relief, or were given a 1 percent lidocaine local anesthetic. Immediately afterward, the patients' discomfort was assessed with a 10-cm visual analog scale.

There was no significant difference in pain scores between women given local anesthetic and women in the forced coughing group, the researchers report, but physicians had a median 2.11 minutes more examination time when they used local anesthesia, the investigators found.

"It is important that one attempts as much as possible to minimize patient discomfort during painful interventions," the authors write. "This study suggests that pain associated with colposcopically directed cervical biopsies can be reduced by forced coughing to the same extent, but in a cheaper and faster way than by injection of a local anesthetic."

Schmid BC, Pilsa S, Heinze G et al. Forced coughing versus local anesthesia and pain associated with cervical biopsy: a randomized trial. Am J Obstet Gynecol. 2008;199:641.e1-641.e3.