Anticipated pain as a predictor of discomfort with intrauterine device placement

Abstract

High levels of anticipated pain correlated with high levels of experienced pain during intrauterine device placement. Nulliparity and a history of dysmenorrhea were also associated with greater discomfort during placement. This information may help guide and treat patients as they consider intrauterine device placement. Future research should focus on interventions to reduce preprocedural anxiety and anticipated pain to potentially decrease discomfort with intrauterine device placement.

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review

“…Eight publications—of which six described RCTs, one was a pilot feasibility study and one was a pooled analysisdescribed nonpharmacological interventions. A further nine publications described factors related to the experience of pain with IUC placement . Of these, one was an RCT, three were non‐RCTs, three were prospective cohort studies, one was a case‐control study, and one was a secondary analysis of the US‐based Contraceptive CHOICE Project …”

“…Eight publications described factors that may help to predict women more likely to experience pain with IUC placement . The identified factors are summarized in Table .…”

“…A secondary analysis of 1149 participants in the US Contraceptive CHOICE Project looked at whether anticipated pain affected actual pain experienced during IUC placement . After controlling for parity, history of dysmenorrhea and type of IUC, higher anticipated pain was associated with an increase in experienced pain (adjusted risk ratio for 1 unit increase in anticipated pain, 1.19; 95% CI 1.14‐1.25) . Nulliparity, history of dysmenorrhea, and placement of an LNG‐IUS (with a 4.8‐mm inserter) were all associated with an increase in mean pain score with IUC placement.…”

“…Nulliparity, history of dysmenorrhea, and placement of an LNG‐IUS (with a 4.8‐mm inserter) were all associated with an increase in mean pain score with IUC placement. As CHOICE was a prospective cohort study, real‐time collection of anticipated and actual pain data limits recall bias and strengthens the study . However, lack of information regarding the use of pain‐relieving interventions, other than the routine offering of premedication with NSAIDs, may be a limiting factor.…”

“…A further nine publications described factors related to the experience of pain with IUC placement. [50][51][52][53][54][55][56][57][58] Of these, one was an RCT, 50 three were non-RCTs, [51][52][53] three were prospective cohort studies, [54][55][56] one was a case-control study, 57 and one was a secondary analysis of the US-based Contraceptive CHOICE Project. 58…”