EFFICACY OF A STANDARDIZED, MULTIMODAL APPROACH TO PAIN CONTROL DURING IUD INSERTION

Objectives

We aimed to evaluate the efficacy of a multimodal “bundle” to reduce pain and complications associated with intrauterine device (IUD) insertion. This bundle included oral naproxen, a high-potency topical anesthetic applied to the cervix, and the presence of an emotional support person. When available, ultrasound guidance was included in the bundle.

Methods

This is a prospective cohort study comparing pain and complications associated with IUD insertion in patients using standard practice, Cohort 1 (n=133), vs. using the pain reduction bundle, Cohort 2 (n=231). We enrolled patients undergoing IUD insertion from May 2022 to March 2024. We prospectively evaluated patient pain scores and qualitative experiences during IUD insertion using a visual analog scale and patient survey. Complications, including expulsion, malposition, infection, and laceration, were evaluated at six weeks.

Results

The mean reported pain score was not significantly lower in the intervention group compared to the control group (4.87/10 vs. 5.02/10, p=0.679) when controlling for parity, history of prior IUD placement, prior cervical procedure, concurrent procedure, type of IUD, age, BMI, and race/ethnicity distribution between groups. Subgroup analyses of copper IUD and nulliparous patients also revealed no significant difference (p=0.85, p= 0.811).

Conclusions

Patients experience pain during IUD insertion despite intervention with a multimodal pain bundle. Despite experiencing pain during IUD insertion, a majority of patients would undergo the procedure in the future and recommend the procedure to a friend. Further research is needed to explore pain control options during IUD insertion.