Multidose Ibuprofen Prior to Intrauterine device insertion (MIPI): a triple blinded randomized controlled trial

Area of Science:

• Reproductive medicine
• Pain management
• Pharmacology

Background:

• Intrauterine device (IUD) insertion often causes significant pain, limiting its use.
• Single-dose Ibuprofen shows limited efficacy for IUD insertion pain.
• Pharmacokinetic data suggest preemptive multi-dose Ibuprofen may offer better pain control.

Purpose of the Study:

• To evaluate if preemptive multi-dose Ibuprofen reduces pain during IUD insertion.
• To assess if this regimen decreases pain 24 hours post-insertion.
• To determine if it minimizes the need for additional analgesia within 24 hours.

Main Methods:

• Triple-masked, randomized controlled trial with Ibuprofen (800 mg x 3 doses) or placebo.
• Primary outcome: pain severity during insertion (Numerical Pain Rating Scale).
• Secondary outcomes: 24-hour pain and analgesia use; intention-to-treat analysis.

Main Results:

• Preemptive multi-dose Ibuprofen significantly lowered insertion pain compared to placebo (median NPRS 5 vs 7, p=0.01).
• No significant differences in pain severity or analgesia use were observed at 24 hours post-insertion.
• A clinically and statistically meaningful reduction in insertion pain was achieved with Ibuprofen.

Conclusions:

• Preemptive multi-dose Ibuprofen effectively reduces pain during IUD insertion.
• The regimen's benefit appears limited to the insertion procedure itself.
• Further research may explore optimal dosing or alternative strategies for sustained pain relief.