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Differing Approaches to Pain Management for Intrauterine Device Insertion and Maintenance: A Scoping Review.

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Intrauterine device (IUD) insertion pain varies by patient factors and methods used. Pharmacological interventions like lidocaine and ketorolac effectively reduce pain, unlike non-pharmacological techniques, highlighting a need for standardized pain management protocols.

Keywords:
intrauterine devices (iud)non-pharmacological treatmentspharmacological treatmenttreatment guidelineswomen's reproduction

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Area of Science:

  • Reproductive Health
  • Pain Management
  • Contraception

Background:

  • Intrauterine devices (IUDs) are effective contraceptives but can cause procedural pain.
  • Existing guidelines for IUD insertion pain management lack uniformity, particularly between the U.S. and other regions.
  • There is a literature gap concerning standardized pain management protocols for IUD implantation.

Purpose of the Study:

  • To address the gap in literature regarding official procedures for pain management during IUD implantation.
  • To review and categorize factors influencing pain during IUD insertion.
  • To identify effective pain mitigation strategies for IUD procedures.

Main Methods:

  • A scoping review was conducted using keywords across PubMed, MEDLINE, and EMBASE.
  • 457 articles were initially identified, with 19 ultimately selected after rigorous screening and quality assessment.
  • Data were categorized into circumstantial factors, non-pharmacological methods, and pharmacological methods.

Main Results:

  • Previous vaginal delivery and lactation were associated with lower pain scores; nulligravid women and Black women reported higher pain.
  • Non-pharmacological methods (insertion techniques, tools, cold compress) did not significantly affect pain levels.
  • Pharmacological methods including lidocaine gel, paracervical blocks, oral ketorolac, and vaginal misoprostol/dinoprostone reduced pain scores.

Conclusions:

  • Significant variability exists in IUD insertion practices and pain management.
  • Circumstantial factors, non-pharmacological, and pharmacological methods influence pain perception and management.
  • Further research is needed to develop standardized protocols for mitigating IUD insertion pain, especially given potential increases in IUD use.