A mystery caller study on pain management options for intrauterine device placement

To understand whether clinics present pain management options for intrauterine device (IUD) placement over the phone and whether these options align with current evidence for effective pain control during placement.

We used a mystery shopper approach and a standardized call script to collect information from a diverse, purposive sample of 100 clinics listed on www.bedsider.org.

We reached responsive personnel at 90 of the 100 selected clinics, of whom 32 (36%) would not provide information about pain control for IUD placement by phone or to non-established patients. Of the 58 clinics that provided information, four (6.9%) reported that they did not provide any options for pain management, and 54 (93.1%) presented at least one pharmaceutical option. The most common was ibuprofen, which was mentioned by 49 clinics (84.5%). Lidocaine, misoprostol, and naproxen were mentioned by 16 (27.6%), 14 (24.1%), and three (5.2%) clinics, respectively.

More than one third of clinics were unable to present pain control options over the phone. Among the 58 clinics that presented options to simulated patients calling to request an IUD placement, evidence-based pain control methods, such as lidocaine blocks, 10% lidocaine spray, or naproxen, were not often presented.

Given the barriers that pain and pre-procedure anxiety pose to uptake of IUDs, it is important for clinic staff to understand current guidelines for pain management during IUD placement as well as the pain control options offered for IUD placements at their clinic.