Pain can be reduced by the cooperation of surgeons and other participants.

In this issue of the Journal, Kokanali et al published an important article entitled “Impact of preprocedural anxiety levels on pain perception in patients undergoing office hysteroscopy”. This observational study enrolled 148 patients who underwent office hysteroscopy (OH). All patients had their anxiety levels assessed and scored using the Spielberger StateeTrait Anxiety Inventory (STAI) questionnaire, which contains two components: STAI-T [i.e., trait (a general tendency to be anxious)], and STAI-S [i.e., state (situational anxiety)]. The authors investigated the effect of various clinical factors and preprocedural anxiety levels on pain perception in these women when they were treated with OH. We commend the authors on the publication of this article, and feel it necessary to comment on its contents. The authors reported that there were significantly positive correlations between in-hospital waiting time (r 1⁄4 0.599, p < 0.001), procedure time (r 1⁄4 0.242, p 1⁄4 0.002), preprocedural trait-state levels (both r 1⁄4 0.68; for both p < 0.001), and procedure-related pain [as assessed by the visual analog scale (VAS)] during OH. In addition, at 60 minutes postoperatively, all aforementioned factors further showed a strongly positive correlation with the VAS. However, there was one difference during the procedure and after the procedure: parity, which contributed to pain after OH but not during OH. Linear regression analysis identified that inhospital waiting time was the most important factor contributing to a high VAS score during OH [odds ratio (OR), 0.475; p < 0.001], although other factors such as STAI-T score may also contribute. However, the VAS at 60 minutes postoperatively was associated with a strong correlation between the STAI-T score and procedure time. This suggests that pain perception is influenced by the procedure itself and by the environment or patient. This article contains other information and results that are intriguing and thus merit further attention. First, a positive correlation has been well studied between the waiting time (i.e., the time from counseling about OH to the performance of OH) and the perception of pain. However, this information, which could otherwise assist practitioners and provide a benefit to patients, is often neglected in the routine of clinical practice. Carta et al found that OH is associated with a level of anxiety that can affect a patient's tolerability of the procedure. A statistically significant positive