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

Kristina Gemzell-Danielsson, Jeffrey Jensen, Ilza Monteiro, Tina Peers, Maria Rodriguez, Attilio Di Spiezio Sardo, Luis Bahamondes

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
JournalActa obstetricia et gynecologica Scandinavica
DOIs
StatePublished - Jan 1 2019

Fingerprint

Contraceptive Agents
Pain
Analgesia
Placebos
Ketorolac
Delivery of Health Care
Dysmenorrhea
Menstruation
Pain Management
Lidocaine
PubMed
Libraries
Fear
Oral Administration
Publications
Dilatation
Anxiety
Randomized Controlled Trials
Databases
Equipment and Supplies

Keywords

  • contraception
  • intrauterine contraception
  • intrauterine device
  • nonsteroidal anti-inflammatory drugs
  • pain
  • women

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives : An updated review. / Gemzell-Danielsson, Kristina; Jensen, Jeffrey; Monteiro, Ilza; Peers, Tina; Rodriguez, Maria; Di Spiezio Sardo, Attilio; Bahamondes, Luis.

In: Acta obstetricia et gynecologica Scandinavica, 01.01.2019.

Research output: Contribution to journalReview article

Gemzell-Danielsson, Kristina ; Jensen, Jeffrey ; Monteiro, Ilza ; Peers, Tina ; Rodriguez, Maria ; Di Spiezio Sardo, Attilio ; Bahamondes, Luis. / Interventions for the prevention of pain associated with the placement of intrauterine contraceptives : An updated review. In: Acta obstetricia et gynecologica Scandinavica. 2019.
@article{caf1b2e1d30140caa95f7048e876040b,
title = "Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review",
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.",
keywords = "contraception, intrauterine contraception, intrauterine device, nonsteroidal anti-inflammatory drugs, pain, women",
author = "Kristina Gemzell-Danielsson and Jeffrey Jensen and Ilza Monteiro and Tina Peers and Maria Rodriguez and {Di Spiezio Sardo}, Attilio and Luis Bahamondes",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/aogs.13662",
language = "English (US)",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Interventions for the prevention of pain associated with the placement of intrauterine contraceptives

T2 - An updated review

AU - Gemzell-Danielsson, Kristina

AU - Jensen, Jeffrey

AU - Monteiro, Ilza

AU - Peers, Tina

AU - Rodriguez, Maria

AU - Di Spiezio Sardo, Attilio

AU - Bahamondes, Luis

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - contraception

KW - intrauterine contraception

KW - intrauterine device

KW - nonsteroidal anti-inflammatory drugs

KW - pain

KW - women

UR - http://www.scopus.com/inward/record.url?scp=85068110097&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068110097&partnerID=8YFLogxK

U2 - 10.1111/aogs.13662

DO - 10.1111/aogs.13662

M3 - Review article

C2 - 31112295

AN - SCOPUS:85068110097

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

ER -