Tramadol, celecoxib ease hysteroscopy pain, but celecoxib may be better tolerated

Last Updated: 2015-12-10

By Megan Brooks

NEW YORK (Reuters Health) - Tramadol and celecoxib are both good options for reducing pain associated with outpatient hysteroscopy but celecoxib may be better tolerated, according to a randomized double-blind placebo-controlled trial conducted in Cairo, Egypt.

"The available evidence before this study did not provide sufficient evidence to support the use of painkillers before outpatient hysteroscopy," Dr. AbdelGany Hassan from Cairo University told Reuters Health by email.

"The take-home message of the study is that oral Celecoxib 200 mg and oral Tramadol 100 mg reduce the pain experienced during and after outpatient hysteroscopy. I believe that units that did not use painkillers before outpatient hysteroscopy will review their clinical practice, and units that used painkillers can justify their practice with the new evidence," Dr. Hassan said.

Tramadol is an opioid analgesic and celecoxib is a COX-2 selective nonsteroidal anti-inflammatory drug.

In the study, 210 women undergoing outpatient hysteroscopy were randomly and evenly split into three groups receiving either oral tramadol 100 mg, celecoxib 200 mg, or oral placebo. All the drugs were given one hour before surgery. Pain perception was assessed using the visual analogue scale (VAS) during the procedure, immediately after, and 30 minutes after the procedure.

"To the best of our knowledge," this is the first study to compare these two different pain medications for pain associated with hysteroscopy, Dr. Hassan and colleagues note in the journal Human Reproduction, online November 29.

Both agents significantly reduced pain during, immediately after and 30 minutes after hysteroscopy compared with placebo. For instance, compared with placebo, tramadol lowered pain scores during the procedure by 1.54 points (p<0.001) on average while celecoxib lowered them by 1.28 points (p<0.001).

There was no marked difference in pain scores between the drugs. Time until no pain was much shorter with tramadol and celecoxib than with placebo, and no significant difference in time until no pain was seen between tramadol and celecoxib.

Four patients who received tramadol had nausea while no side effects were reported in the celecoxib arm; "however a larger sample size is required before drawing firm conclusions about the lack of side effects," the team points out.

"We believe that the results of this study could have significant clinical implications as the lower pain scores in the treatment group with shorter time until no pain may have a positive impact on improving patient satisfaction and minimizing the rate of procedure failure due to pain. This is more true in the celecoxib group who did not report side effects from treatment, further improving patient satisfaction by avoiding intolerable side effects," Dr. Hassan and colleagues write.

"Further studies are needed to test efficacy of celecoxib with different times of administration before hysteroscopy to see if this will affect the perception of pain," they add.

The study had no funding and the authors reported no conflicts of interest.

SOURCE: http://bit.ly/1Y28ulr

Human Reprod 2015.