Global Discomfort Research Articles

Effect of wearable chair on gait, balance, and discomfort of new users during level walking with anterior loads

Introduction: Walking with anterior loads is common in industrial scenarios, but as exoskeletons are increasingly used in work environments to alleviate musculoskeletal disorders (MSDs), this new “human-robot” system composed of the human body and exoskeleton may be associated with new risks and harm that warrant further investigation. Therefore, this study will discuss the effect of a wearable chair on the gait, balance, and discomfort of new users with different weights of anterior loads during level walking. Method: Twenty-two healthy subjects (sex balanced) participated in the experiment. Each exposure comprised one of two exoskeleton states (with/without) and four load conditions: No carried load, carrying an empty box (0.3 kg), 5%Body Weight (BW), and 10%BW. The order of exoskeleton states and load conditions was randomly assigned. Using an eight-camera motion capture system to record the entire movement. And the subjective discomfort and perceived balance after each exposure were recorded on an 11-point numeric rating scale, respectively. Using SPSS 26.0 software (IBM Inc., Chicago) to conduct statistical analyses. Results: Level walking with a wearable chair in different load conditions significantly affected gait parameters (like cadence) and gait balance. The perceived balance decreased with the exoskeleton, consistent with objective results. For subjective discomfort, wearing the exoskeleton significantly impacted global discomfort. Also, it increased the local discomfort of the shoulders, waist, thighs, shanks, and feet/ankles. Conclusions: For new users, the risk of losing balance or falling may be increased when wearing an exoskeleton for non-target task behaviors (level walking/anterior load), and caution is recommended when the anterior load exceeds 5% BW. Practical Application: The proposed strategy for assessing human gait, balance, and discomfort in wearable chairs may be applied during the iterative design of the product. These controls will help develop training programs and implementation guidelines for this exoskeleton type.

Study of the comfort aircraft norm

In long range aircraft, one reason of discomfort of the passengers are the vibrations and the noise induced by the rotation of the engine. This induces high-level single-frequency excitations (both for noise and vibration). The frequency (located between 25 and 55 Hz) and the amplitude of these excitations vary depending on flight parameters. This study investigates the influence of the frequency and the level of vibration and noise stimuli to discomfort. The aim is to build a global discomfort model. Subjective experiments were carried out in the laboratory, on a test bench allowing to control vibration and noise stimuli. Volunteers separately assessed the vibration, noise and global discomfort. Foot, seat, backrest and armrests accelerations were measured for each participant and each stimulus. As expected, noise or vibration discomfort depends on the excitation level; but no influence of the frequency could be detected. Finally, it appears that specific vibration discomfort strongly influences global discomfort.

A Topical Scalp Serum Containing Adenosine, MgSO4, Vitamin CG, and Pre‐ and Probiotic Fractions Reduces Discomfort and Associated Symptoms of Sensitive Scalp

Purpose. Sensitive scalp (SScalp) is characterized by abnormal and nociceptive sensations, such as stinging and itching, that lead to scalp discomfort. This study assessed the benefit of a once‐daily serum containing Adenosine, Magnesium Sulfate (MgSO4), Vitamin C Glucoside (CG), and pre‐ and probiotic fractions in subjects with SScalp. Methods. An open‐label, single center study in adult subjects with a Global Scalp Discomfort (GSD) score of ≥8 (0–27), defined as the sum of individual symptom scores (0–9) for itching, stinging, and warming sensations. The frequency of scratching was self‐declared. Evaluations were performed immediately after the 1st application (D0Timm) and at D21, during which the cosmetic acceptability was additionally assessed. Transepidermal water loss and skin hydration were assessed at baseline, D21, and D28. Squalene (SQ) and SQOOH were analyzed at D0T0, D21T0, and D28. Tolerance was assessed throughout the study. Results. 42 subjects (30 women and 12 men) participated in this study. The mean age was 44.0 ± 13.0 years. At baseline, the mean GSD was 13.9 ± 3.28. The GSD and symptoms significantly (p < 0.0001) improved at D0Timm and lasted until the end of the study (D28), with insignificant worsening. There was a significant reduction of SQOOH at D21 and D28. Subject satisfaction was high, associated with a good tolerance. A similar and significant (p < 0.0001) improvement was observed for subjects with more severe symptoms and a GSD score ≥14 at baseline. Conclusion. The topical serum significantly reduces SScalp, global discomfort, and oxidative stress and is beneficial in the management of sensitive scalp. This TRIAL is registered with NCT05630027.

Topical sirolimus solution for lingual microcystic lymphatic malformations in children and adults (TOPGUN): study protocol for a multicenter, randomized, assessor-blinded, controlled, stepped-wedge clinical trial

BackgroundLingual microcystic lymphatic malformations (LMLMs) are rare congenital vascular malformations presenting as clusters of cysts filled with lymph fluid or blood. Even small well-limited lesions can be responsible for a heavy burden, inducing pain, aesthetic prejudice, or oozing, bleeding, infections. The natural history of LMLMs is progressive worsening punctuated by acute flares. Therapeutic options include surgery, laser excision, and radiofrequency ablation but all are potentially detrimental and expose to local relapse. Therefore, the management frequently relies on a “watchful waiting” approach. In complicated LMLMs, treatment with oral sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is often used. Topical applications of sirolimus on the buccal mucosae have been reported in other oral diseases with good tolerance and none to slight detectable blood sirolimus concentrations. We aim to evaluate the efficacy and safety of a 1 mg/mL sirolimus solution applied once daily on LMLM of any stage in children and adults after 4, 8, 12, 16, 20, and 24 weeks of treatment compared to usual care (no treatment).MethodsThis is a randomized, multicentric study using an individually randomized stepped-wedge design over 24 weeks to evaluate topical application of a 1 mg/mL sirolimus solution once daily, on LMLM, versus usual care (no treatment), the control condition. Participants begin with an observational period and later switch to the intervention at a randomized time (week 0, 4, 8, or 12). Visits occur every 4 weeks, either in the study center or by teleconsulting. The primary outcome will be the evaluation of global severity of the LMLM on monthly standardized photographs by 3 independent blinded experts using the physical global assessment (PGA) 0 to 5 scale. Secondary outcomes will include lesion size measurement and quality of life assessment, investigator, and patient-assessed global disease and specific symptoms (oozing, bleeding, sialorrhea, eating impairment, taste modification, aesthetic impairment, pain, and global discomfort) assessment. A biological monitoring will be performed including residual blood sirolimus concentration and usual laboratory parameters.DiscussionGiven the disappointing state of current treatment options in LMLMs, topical sirolimus could become firstline therapy in treating LMLMs if its efficacy and safety were to be demonstrated.Trial registrationClinicalTrials.gov NCT04128722. Registered on 24 September 2019.EudraCT: EUCTR2019-001530-33-FRSponsor (University Hospital Center of Tours – CHRU Tours): DR190041-TOPGUNFrench regulatory authorities: ID RCB: 2019-001530-33

Model of sound and vibration discomfort in helicopter cabins

Noise and vibrations are major sources of discomfort in helicopter cabins and helicopter manufacturers are seeking to estimate passenger discomfort based on noise and vibration measurements. To this end, series of perceptive experiments have been conducted to link subjective assessments of discomfort to objective measurements. Firstly, it has been shown that noise discomfort is governed by perceived intensity and an acoustic comfort equation has been established based on a sound loudness metric. A second series of tests is presented in this document and aims to estimate the global discomfort due to simultaneous noise and vibrations. Discomfort indicators specific to noise and vibrations were used to create a global discomfort equation. This equation shows a similar contribution to the global discomfort from the two sources but demonstrates an interaction term which disadvantages comfort if one of the sources is dominant.

Evaluation of Carboxymethylcellulose Sodium plus Glycerin (Optive®) in Ocular Discomfort after Anti-Vascular Endothelial Growth Factor Intravitreal Injection Therapy: A Prospective Study

Objective: The aim of this study was to evaluate the efficacy of a mix of carboxymethylcellulose and glycerin (Optive®) after intravitreal injection therapy (IVT) with anti-vascular endothelial growth factor for reducing ocular discomfort in patients. Methods: We prospectively included patients who were naïve to any IVT. No artificial tear treatment was prescribed after the first IVT. After the second IVT, all patients instilled 3 drops per day of Optive® for 3 days. Every patient answered a questionnaire concerning the ocular discomfort at 72 h after both IVTs and a questionnaire about tolerance to treatment after the second IVT. Results: We included 45 patients (mean age 72.3 years [range 23–94], 25 females); 14 (34.1%) reported a feeling of grittiness after the first IVT but not after the second (p = 0.01); 12 (29.3%) complained of global discomfort after the first IVT but not after the second (p = 0.14); and 11 (26.8%) reported a watery eye after the first IVT but not after the second (p = 0.21); 37/45 (82%) patients felt ocular discomfort after IVT. Conclusion: Most patients felt ocular discomfort after IVT. Instillation of Optive® significantly alleviated the feeling of grittiness for more than half of the patients.

Ergonomics risk assessment among maintenance operators in a Tunisian railway company: A case study

AbstractRailway truck maintenance plays a crucial role for rail transport. It aims at ensuring the availability of the equipment and the safety of the operations. However, maintenance activities often involve uncommon work and nonroutine tasks and it is obvious that maintenance operators are more threatened than other employees to be exposed to various hazards in their workplace. In Tunisia, the prevalence of occupational accidents and injuries among maintenance workers is not well documented. The target of this cross‐sectional study is to assess ergonomics risks associated with maintenance activities in a railway company. Data collection was carried out through a self‐administrated questionnaire and via direct observations. The Body Parts Symptom Survey (BPSS) was used to identify the discomfort level of the workers. More than 100 maintenance operators working in nine different workshops were involved in this study. From BPSS results, this paper proposed a new method to calculate the discomfort index related to each body part in order to calculate the global discomfort index (GDI) for each workshop. Results showed that the most hazardous workshop was rail‐car maintenance workshop (GDI = 43.06). Four main tasks were assessed with normalized score. Final scores were found to be extremely high. To remedy the raised problems, new adjustable workstations were proposed, which showed a considerable improvement on workers’ postures.

TEFL/TESOL teachers on the move: mobility and culture

PurposeThe purpose of this paper is to discuss the story of 15 TEFL/TESOL English language teachers who spend their lives working globally.Design/methodology/approachInterviews from the research based on the grounded approach generated, among others, three inter-related themes, namely, the global drift, distinctive cultural dispositions and the concept of global quality.FindingsThe global drift symbolizes interviewees’ mobility pattern and captures their Hong Kong experience in four states – adaptation, drifting in global comfort, drifting in global discomfort and bitter/sweet home, each representing a different quality of mobility which contributes to the development of cultural dispositions. Findings of cultural disposition home and openness are considered in relation to studies of its kind. Four aspects of home perceptions in the data are identified. While interviewees developed complex and varied notions of home, it is argued that the geographical home remains a significant resource in the making of home. Data also suggest that most interviewees’ openness is limited – it is selective, functional and transient. Global quality, a concept emerged from the research, summarizes the distinctive cultural traits of the community of the globals. It overlaps with, but does not necessarily equate with, cosmopolitanism.Originality/valueThe conclusion relates the study, including the concepts generated from this research, to cosmopolitanism. Two theoretical constructs are employed in the analysis: form of mobility and nature of mobility.

Pain and Vertebral Dysfunction in Dry Immersion: A Model of Microgravity Simulation Different from Bed Rest Studies

Background Astronauts frequently experience back pain during and after spaceflight. The aim of this study was to utilize clinical methods to identify potential vertebral somatic dysfunction (VD) in subjects exposed to dry immersion (DI), a model of microgravity simulation. Method The experiment was performed in a space research clinic, respecting all the ethical rules, with subjects completing three days of dry immersion (n = 11). Assessments of VD, spine height, and back pain were made before and after simulated microgravity. Results Back pain was present in DI with great global discomfort during the entire protocol. A low positive correlation was found (Pearson r = 0.44; P < 0.001) between VD before DI and pain developed in the DI experiment. Conclusions There is a specific location of pain in both models of simulation. Our analysis leads to relativizing constraints on musculoskeletal system in function of simulation models. This study was the first to examine manual palpation of the spine in a space experience. Additionally, osteopathic view may be used to select those individuals who have less risk of developing back pain.

Can subjective comfort be used as a measure of plantar pressure in football boots?

ABSTRACTComfort has been shown to be the most desired football boot feature by players. Previous studies have shown discomfort to be related to increased plantar pressures for running shoes which, in some foot regions, has been suggested to be a causative factor in overuse injuries. This study examined the correlation between subjective comfort data and objective plantar pressure for football boots during football-specific drills. Eight male university football players were tested. Plantar pressure data were collected during four football-specific movements for each of three different football boots. The global and local peak pressures based on a nine-sectioned foot map were compared to subjective comfort measures recorded using a visual analogue scale for global discomfort and a discomfort foot map for local discomfort. A weak (rs = −0.126) yet significant (P < 0.05) correlation was shown between the peak plantar pressure experienced and the visual analogue scale rated comfort. The model only significantly predicted (P > 0.001) the outcome for two (medial and lateral forefoot) of the nine foot regions. Subjective comfort data is therefore not a reliable measure of increased plantar pressures for any foot region. The use of plantar pressure measures is therefore needed to optimise injury prevention when designing studded footwear.

The postoperative discomfort inventory: A psychometric analysis

Background: Discomfort in the postoperative period is common and may hinder patients’ recovery. Factors causing postoperative discomfort have been identified, but a validated tool to assess postoperative discomfort is lacking. We aimed to evaluate the reliability and validity of an instrument designed to assess postoperative discomfort, the Postoperative Discomfort Inventory (PDI). Methods: We designed a psychometric study that included several longitudinal substudies to establish the preliminary reliability and validity of the PDI. We included all patients in surgical wards on recruiting days who provided written informed consent until the completion of the expected sample size. The study was performed in three samples. The Baseline sample included 125 patients, the Sensitivity sample 51 included patients, and the Recall sample 57 included patients. Discomfort was evaluated using the PDI. Internal-consistency reliability, factor structure, test-retest reliability, and validity were calculated. Results: Reliability analysis scores reduced the number of items from eleven to nine. Test-retest reliability analysis showed that PDI is sensitive to monitor changes in postoperative discomfort and showed high intraclass correlation in the Recall sample. Validity analysis found that the PDI correlated with the McGill Pain Questionnaire, but correlations were higher with the Global Discomfort Intensity measure. Conclusions: The PDI is a valid and reliable instrument that can help patients describe postoperative discomfort and thereby improve nursing care.

Hong Kong-based TEFL/TESOL global academics: life, culture, mobility, globalisation and cosmopolitanism

This paper is about a qualitative research concerning a group of expatriates' (TEFL/TESOL English language teachers) experiences in Hong Kong. Data related to their life, attitudes and cultural dispositions are discussed under four different states, namely, Adaptation, Drifting in Global Comfort, Drifting in Global Discomfort and Bitter/Sweet Home. Together, these contribute to their mobility pattern – the Global Drift. The study discusses their global experiences and situations relating to the interplay of personal choice on the one hand and changing global and local processes and conditions on the other. It is argued that this is a self-perpetuating group sustained and reproduced by a Global Quality including distinct cultural dispositions, concepts of home and the reproduction of third-culture-kids, who are tailor-made for twenty-first-century mobile work. Finally, the research is situated in the study of cosmopolitanism, particularly in the identification of cosmopolitans and their dispositions. Alternative ways of theorising home (as interactive continuums) and issues related to mobility and dispositions will be discussed briefly.

Pilot Study of Human Recombinant Hyaluronidase–Enhanced Subcutaneous Hydration and Opioid Administration for Sickle Cell Disease Acute Pain Episodes

ABSTRACTThe objective of this study was to determine the feasibility of protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration and opioid administration in adults presenting to the emergency department (ED) with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. Pain intensity and pain relief were recorded hourly. Total morphine equivalents and fluid volume, total pain relief (TOTPAR), patient- and physician-perceived global efficacy, patient-perceived global SC needle discomfort, physician-rated ease of needle placement, and adverse effects were noted. Ten patients (6 males, 4 females), mean age 32.9 years (23–56 years) completed the trial. Mean pain intensity scores fell 25% (from 9.2 to 6.9) from baseline and mean 4-hour TOTPAR score was 4 (maximum: 16). A mean total of 119 mg (70–170 mg) morphine equivalents and 846 mL (200–1650 mL) normal saline were administered. Mean patient and physician global perceived efficacy ratings were 3.4 and 4.2 (of 5). Patient global discomfort of SC needle presence was 2.7 (of 10), and ease of needle placement was physician rated at 4 (of 4; easiest). Patients experienced mild swelling and stinging at the SC site, and no infusion required discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous hydration and opioid administration appear feasible from this pilot study. These results need confirmation in a controlled clinical trial.

Abstracts from the TOXINS 2012

Abstracts from the TOXINS 2012

Development of objective discomfort evaluation indicators for a task-oriented motion using less constrained motion concept: application to automotive pedal clutching task

This paper presents a method to develop objective discomfort evaluation indicators for a task oriented motion using the concept of less constrained movement. The basic idea is to compare imposed and less constrained movements in order to identify relevant biomechanical parameters for defining objective discomfort indicators. The task of automotive pedal clutching was chosen for illustrating the proposed method. Based on discomfort questionnaire and motion analysis of the experimental data, four discomfort indicators were proposed. Two of them were based on the ankle joint angle around flexion/extension axis at the beginning and the end of the clutch pedal depression. The third one was defined using knee flexion/extension joint torque at the end of the clutch pedal depression. The last indicator was defined as the relative lateral position of the heel compared to the average pedal lateral position for less constrained configurations. A global discomfort function was also defined as a weighted sum of all indicators. Globally, the proposed global discomfort indicator succeeded in differentiating the tested configurations in agreement with experimental observation. As expected, less discomfort rating is obtained for less constrained movement when compared with the corresponding imposed one.

Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: Resection of the musculus uvulae

Objective To assess the outcome of a modified uvulopalatopharynbgoplasty (UPPP) technique with preservation of the uvula mucosa and partial resection of the musculus uvula. Study Design and Methods A prospective randomized controlled trial. Sixteen male patients underwent a classic UPPP, and another 16 male patients underwent a modified UPPP. The parameters evaluated were the subjective symptom score, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Stanford Sleepiness Scale (SSS), and polysomnography results. Results Postoperative snoring, apnea, morning headache, daytime sleepiness, pharyngeal foreign body sensation, and global discomfort were not significantly different between the two groups. Among seven subjective measures of sleep quality from the PSQI, the subjective sleep quality was significantly improved in both groups. Postoperatively, the SSS was not significantly changed in both groups; however, the ESS was significantly improved in both groups. The polysomnographic findings showed a statistically significantly improvement in the apnea index and the apnea-hypopnea index. Conclusion Although the modified group did not have more profound improvement in sleep quality and decreased postoperative pharyngeal discomfort, modified UPPP was an effective surgical method for the treatment of obstructive sleep apnea-hypopnea syndrome.

Core Temperature Cooling in Healthy Volunteers After Rapid Intravenous Infusion of Cold and Room Temperature Saline Solution

Studies have suggested that inducing mild hypothermia improves neurologic outcomes after traumatic brain injury, major stroke, traumatic hemorrhage, and cardiac arrest. Although infusion of cold normal saline solution is a simple and inexpensive method for initiating hypothermia, human cold-defense mechanisms potentially make this route stressful or ineffective. We hypothesize that rapid infusion of 30 mL/kg of cold (4 degrees C, 39.2 degrees F) 0.9% saline solution during 30 minutes to healthy subjects (aged 27 [standard deviation (SD) 4] years) will reduce core body temperature to the therapeutic range of 33 degrees C to 35 degrees C (91.4 degrees F to 95 degrees F). Sixteen subjects were randomly assigned to receive either cold (4 degrees C, 39.2 degrees F) or room temperature (23 degrees C, 73.4 degrees F) normal saline solution. Subjects were not informed of their assignment, but blinding was not possible after initiation of the infusion. Core temperature, skin temperature, and vital signs were recorded every 2 minutes. Subjects indicated global discomfort during the infusion on a 100-mm visual analog scale at 5-minute intervals. Core temperature decreased in both the cold saline solution (1.0 degrees C [SD 0.4 degrees C]/1.8 degrees F [0.7 degrees F]) and room temperature saline solution (0.5 degrees C [SD 0.1 degrees C]/0.9 degrees F [0.2 degrees F]) groups, whereas skin temperature was unchanged. Slopes calculated from the core temperature cooling curves indicate that the majority of cooling occurred during the first half of the infusion. Examination of the core temperature cooling curves revealed a 2-phase temporal pattern in 30-minute cooling curves. The early phase, spanning 0 to 14 minutes, demonstrated rapid cooling in both groups, with a larger effect observed in subjects receiving cold saline solution. In this pilot study of healthy volunteers, rapid administration of cold saline solution to awake normothermic volunteers resulted in 1 degrees C (1.8 degrees F) cooling but did not induce a therapeutic plane of hypothermia. This change in core temperature was not accompanied by significant changes in skin temperature. These data suggest that a reduction in core temperature of about 1 degrees C (1.8 degrees F) can be achieved in healthy humans before a thermoregulatory response is triggered and that rapid infusion of cold intravenous fluids is insufficient by itself to overcome this response. The clinically relevant control arm of room temperature saline solution also resulted in mild core cooling.

Prospective evaluation of a new ultrathin one-plane bending videoendoscope for transnasal EGD: a comparative study on performance and tolerance

EGD, with small-diameter endoscopes, is routinely performed via a nasal route in adults. To evaluate a new ultrathin one-plane bending videoendoscope for transnasal EGD. Single center, prospective, randomized study. Edouard Herriot University Hospital. A total of 122 outpatients (median age, 49 years [18-81 years], 62 men and 60 women) were randomized into 2 groups (on a 2:1 basis) according to the endoscope used: (1) a standard 5.9-mm-diameter videoendoscope (80 patients) or (2) a one-plane bending high resolution 4.9-mm-diameter videoendoscope (42 patients). The operator assessed the quality of examination by using standard scores or a 100-mm visual scale. Patients quantified tolerance by using a 100-mm visual scale. The duration of the procedure was the same in each group. The feasibility of transnasal insertion was significantly higher when using the 4.9-mm-diameter endoscope (97.61% [41/42 patients] vs 88.75% [71/80 patients], P<.05). The tolerance of EGD was significantly better in the group with the small videoendoscope, for global discomfort, pain, belching, and bloating. Similarly, acceptation of a new EGD in similar conditions was higher in group 2 (92.9% vs 80%, P<.05). The quality of examination (global, lavage, inflation, suction) was not different between the 2 groups. Evaluation of patient tolerance and quality of examination was based on subjective features. Availability of a new ultrathin one-plane bending videoendoscope represents a major technical improvement for transnasal EGD, which significantly improves both feasibility and patient tolerance, without affecting the quality of the examination.

Amélioration de la symptomatologie chez des patients atteints de sécheresse oculaire et traités oralement par des acides gras polyinsaturés

Polyunsaturated fatty acids (PUFAs) are involved in inflammatory pathways via prostaglandins. Conjunctival inflammation is a hallmark of all dry eye syndromes. We investigated the role of dietary n-6 and n-3 fatty acids in patients suffering from ocular dryness.Seventy-one patients presenting with mild to moderate dry eye syndromes were randomly assigned to Nutrilarm or placebo capsules, twice a day for 6 months. The Schirmer test, BUT, fluorescein staining, and lissamin green stainings were performed at inclusion and after 1, 3, and 6 months. Furthermore, a questionnaire related to the dry eye symptoms and global discomfort was provided at every visit.The Schirmer test, BUT, fluorescein staining, and lissamin green stainings were improved with treatment when compared to placebo but the difference was not statistically significant. The efficacy evaluated by the patients and the investigator were nearly significant (p=0.052 and p=0.054, respectively). For some signs, such as reflex tearing and conjunctival hyperemia, the improvement reached the threshold of significance (p=0.047 and p=0.045, respectively). The same results were found with skin quality and emotional condition, which were improved (61% with treatment versus 36% with placebo).This double-masked pilot study shows that PUFAs seem to be an interesting tool to alleviate the symptoms related to dry eye syndrome. These results should be confirmed using a larger study population.

Evaluation of Pain in Three Hysterosalpingography Techniques: Metal Cannula With and Without Paracervical Blockage and Balloon Catheter

The objective of this study was to assess discomfort or pain in patients undergoing hysterosalpingography using three different techniques. Eighty-nine patients were randomly assigned to one of three groups. In group 1, 30 patients underwent the technique performed with a metal cannula without anesthetic; in group 2, 29 patients underwent the technique performed with a metal cannula with previous paracervical anesthetic block; in group 3, 30 patients submitted to the procedure performed with a flexible balloon catheter. Each patient completed two questionnaires, Q1 and Q2: Q1 assessed their personal, clinical, and surgical history, and Q2 provided the visual analog scale (VAS) for pain assessment. The investigator also evaluated discomfort at each potentially painful stage of the procedure based on the patient's verbal expression, physical manifestations, or both. In terms of global discomfort experienced during hysterosalpingography, group 1 had the highest mean VAS score, whereas scores did not significantly differ between groups 2 and 3. During cervical grasping, group 2 experienced less discomfort than group 1. A comparison of pain associated with cervical grasping and balloon inflation (group 3 only) revealed that the highest levels of discomfort occurred during cervical grasping without anesthesia (group 1), followed by balloon inflation inside the cervix (group 3), and, last, cervical grasping after paracervical block (group 2). Performing hysterosalpingography with a flexible balloon catheter or metal cannula with previous paracervical block produced similar levels of pain; however, both techniques appear to be more comfortable than the traditional technique (i.e., metal cannula without anesthesia).