Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review. (27th June 2019)

• Record Type: Journal Article
• Authors: Gemzell‐Danielsson, Kristina; Jensen, Jeffrey T.; Monteiro, Ilza; Peers, Tina; Rodriguez, Maria; Di Spiezio Sardo, Attilio; Bahamondes, Luis
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 98:Number 12(2019)
• Page Start: 1500
• Page End: 1513
• Publication Date: 2019-06-27
• Subjects: contraception -- intrauterine contraception -- intrauterine device -- nonsteroidal anti‐inflammatory drugs -- pain -- women; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13662
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: A 2013 review found no evidence to support the routine use of pain relief for intrauterine contraceptive (IUC) placement; however, fear of pain with placement continues to be a barrier to use for some women. This narrative review set out to identify (1) new evidence that may support routine use of pain management strategies for IUC placement; (2) procedure‐related approaches that may have a positive impact on the pain experience; and (3) factors that may help healthcare professionals identify women at increased risk of pain with IUC placement. A literature search of the PubMed and Cochrane library databases revealed 550 citations, from which we identified 43 new and pertinent studies for review. Thirteen randomized clinical trials, published since 2012, described reductions in placement‐related pain with administration of oral and local analgesia (oral ketorolac, local analgesia with different lidocaine formulations) and cervical priming when compared with placebo or controls. Four studies suggested that ultrasound guidance, balloon dilation, and a modified placement device may help to minimize the pain experienced with IUC placement. Eight publications suggested that previous cesarean delivery, timing of insertion relative to menstruation, dysmenorrhea, expected pain, baseline anxiety, and size of insertion tube may affect the pain experienced with IUC placement. Oral and local analgesia and cervical priming can be effective in minimizing IUC placement‐related pain when compared with placebo, but routine use remains subject for debate. Predictive factors may help healthcare professionals to identify women at risk of experiencing pain. Targeted use of effective strategies in these women may be a useful approach while research continues in this area.