Music and oral premedication for pain management during outpatient hysteroscopy: results from a randomised controlled trial

Outpatient hysteroscopy is a common procedure, but pain can lead to failure and poor patient experience, especially in women without previous vaginal delivery and postmenopausal women.

To compare the use of music during outpatient hysteroscopy with oral pre-procedural analgesia or no pain control intervention on perioperative and postoperative pain.

A randomised controlled trial was conducted at the outpatient hysteroscopy service of the University of Cagliari between December 2024 and June 2025. Women undergoing outpatient hysteroscopy were allocated to a music group (pre-defined instrumental relaxing music without lyrics, delivered through a Bluetooth speaker throughout the procedure), an oral premedication analgesia group (ibuprofen 200 mg + paracetamol 1000 mg, 90 min pre-procedure), or a control group (no pre-pharmacological or music-based analgesic support). A 5-mm hysteroscope and standardised vaginoscopic "no-touch" technique were used.

The primary outcome was maximum pain on a 0-10 visual analogue scale (VAS) intraoperatively (T0) and 30 minutes post-procedure (T1). Secondary outcomes included operative time, successful procedural completion, and complications. A pre-specified subgroup analysis was performed to explore potential treatment-by-previous vaginal delivery status (no previous vaginal delivery vs. women with a previous vaginal delivery) and menopausal status (reproductive age vs. menopause) interactions.

Two hundred sixty-four women were randomised; 88 to intraprocedural music, 89 to pre-operative analgesia, and 87 to no pain control intervention. Peak intraoperative pain did not differ across groups (VAS mean ± standard deviation: 3.4±1.0 in the music group, 3.5±1.45 in the oral premedication group, and 3.6±0.9 in the control group; P=0.35). Post-procedural pain at 30 minutes was also similar across groups (1.5±1.4, 1.5±1.5, and 1.7±1.1, respectively; P=0.24). Operative time was comparable across groups (mean: 3.2, 3.1, and 3.2 minutes; P=0.13). Procedure completion rates did not differ between groups (P=0.62), and no complication rates or drug-related adverse events were observed. In exploratory analyses across the overall cohort, women with no previous vaginal delivery (n=82) reported higher intra-procedural pain scores than women with a previous vaginal delivery (n=182) (VAS 4.1±0.9 vs 3.2±0.9; P=0.032). Similarly, postmenopausal women (n=76) reported higher pain scores than women of reproductive age (n=188) (VAS 4.0±0.9 vs. 3.4±0.9; P=0.023).

The use of intraoperative music or pre-procedural analgesia with oral ibuprofen-paracetamol does not reduce pain compared with standard outpatient hysteroscopy.

Intraoperative music and oral analgesia during outpatient hysteroscopy are not more effective than standard hysteroscopy for reducing pain associated with outpatient hysteroscopy.