PASS, VAS, or satisfaction: A prospective observational study of IUD placement pain experiences

To identify factors associated with unacceptable Patient Acceptable Symptom State (PASS) responses, Visual Analog Scale (VAS) scores, and satisfaction at time of intrauterine device (IUD) placement.

Recruitment occurred at six Utah clinics between 6/24-2/25. Participants completed procedure surveys on demographics, reproductive history, anticipated pain, anxiety, and coping skills. Post-placement surveys assessed PASS responses, experienced pain by VAS (1-100mm) and satisfaction with IUD placement (5-point Likert scale). We determined factors associated with unacceptable PASS responses and a cut point delineating "low" vs "high" pain to assess measure associations.

Of 194 participants, 21% (n = 41) reported an unacceptable PASS, which was associated with higher mean anticipated (65 mm vs 51 mm; p_adj=0.01) and experienced (76 mm vs 46 mm; p_adj<0.001) pain, prior sexual assault (55% vs 28%; p_adj=0.016), or violent death of someone close (25% vs 7%; p_adj=0.024). In controlled analysis, higher experienced pain predicted unacceptable PASS (OR:1.10;95%CI:1.06, 1.14). "High" pain (≥61mm) occurred in 44% of all participants. Of those with high pain, 55% reported an acceptable PASS response. History of prior pelvic exam (p = 0.02, p_adj 0.20), prior IUD placement (p = 0.003; p_adj 0.12), or violent death of someone close (p = 0.011; p_adj 0.13) influenced unacceptable PASS responses in this group. Of all participants, 21% reported dissatisfaction (n = 16) or neutral response (n = 24) regarding their IUD placement, among which only 13 reported an unacceptable PASS (32%). Satisfaction was influenced by mean VAS score (61 mm dissatisfied/neutral vs 50 mm satisfied; p = 0.01; p_adj 0.90).

IUD placement pain level may influence satisfaction, but less than half of those with high pain (≥61mm) reported an unacceptable experience.

IUD placement pain experiences are multi-dimensional and cannot be described by pain level alone. High levels of placement pain influence satisfaction and overlap but are not collinear with acceptability responses. Acceptability of IUD may be subject to temporal bias and influenced by whether their goals/needs are met and whether the pain was ultimately worth it.