Variability in pain management utilization during intrauterine device insertion: a retrospective review

Area of Science:

• Reproductive Health
• Pain Management
• Ambulatory Care

Background:

• Social media highlights inadequate pain management during intrauterine device (IUD) insertion.
• Paracervical blocks are evidence-based for IUD insertion pain but underutilized.
• Factors influencing paracervical block use at the patient visit level are poorly understood.

Purpose of the Study:

• Estimate pain management technique utilization during IUD insertion.
• Evaluate patient- and provider-based factors associated with pain management methods.

Main Methods:

• Retrospective chart review of billing data from an academic medical center (Jan 2021-Dec 2021).
• Analysis of IUD insertions and pain management methods, including paracervical blocks.
• Multivariable logistic regression assessed factors (parity, gynecologic condition, race/ethnicity, insurance) associated with paracervical block use.

Main Results:

• 73.1% of IUD insertions lacked documented pain management.
• Paracervical block use was 12.5%; NSAIDs (22.2%) and acetaminophen (7.8%) were more common.
• Nulliparous patients and those with gynecologic conditions had higher odds of receiving a paracervical block (aOR 2.61 and 2.23, respectively).
• Paracervical block use was concentrated among a small number of providers.

Conclusions:

• Pain management for IUD insertion is underused in ambulatory settings.
• Paracervical block utilization is provider-dependent, not patient-centered.
• Increased attention to pain control and clinician education for IUD insertion is needed.