Pain Management For Office Based Surgery

I don’t normally write these little blurbs to ‘blow my own horn’ but in this case there’s a message I’d like to share.

Minimally Invasive Gynecology In this month’s Journal of Minimally Invasive Gynecology I wrote an editorial entitled “Pain management for office-based surgery: expanding our flight envelope. My motivation for writing this article was quite simple.  Gynecologists, as a group, are poorly educated and worse—in denial—about the simple issue of pain management for office-based procedures.

Much of what we do in an office setting—even minor things such as an IUD insertion, a biopsy of the cervix or uterine lining tissue, can be very painful for some women.  This doesn’t make these women “wimps”.  The simple fact is that women (like men) find some ‘procedures’ tolerable and others intolerable.

I can be tough about some things—colonoscopy for instances—but I would never consider going to a dentist and having a cavity filled without a local anesthetic block. Many other men and women find such anesthesia unnecessary; more power to them.  Others simply go to a dentist that offers “sedation dentistry.”  The fact remains that we are all different and our differences need to be respected and considered when a physician suggests any time of office-based procedure.

Gynecology is very different from dentistry.  If you read the editorial you’ll note that many procedures done in the gynecologist’s office (endometrial biopsies, D and Cs’, hysteroscopies, endometrial ablation and even IUD insertions) are done under “paracervical block” or PCB.  I don’t know how long this outdated and useless procedure has been around—but it’s certainly been used routinely during my 36 year professional career.  What physicians don’t understand (and in some cases refuse to admit) is that it doesn’t work.  Unlike dentistry where it’s easy to “numb” your teeth and gums it simply isn’t the case for women’s pelvic organs. As the editorial points out, numerous studies in the United States and China make it clear that the “block” not only doesn’t work in reducing pain, but that it is painful to administer.  In a very real sense this is one instance where the “cure is worse than the disease.”

The editorial makes two important points:  first (we’ve already stated) that paracervical block does NOT work and second that physicians have safe and simple-to-use medications to reduce anxiety and pain in an office-based setting.  These medications don’t require expensive accreditation and are available to any physician who wants to take the time necessary to make you comfortable.

But if you don’t know about this issue you don’t have the information necessary to request the comfort you deserve during office-based procedures.  So pass this information along.  In general, doctors are very responsive to your needs—but if you don’t ask you may not get the comfort you deserve.

Morris Wortman, MD