Anticipated Pain During Intrauterine Device Insertion

Tegan A Hunter, Sarita Sonalkar, Courtney A Schreiber, Lisa K Perriera, Mary D Sammel, Aletha Y Akers, Tegan A Hunter, Sarita Sonalkar, Courtney A Schreiber, Lisa K Perriera, Mary D Sammel, Aletha Y Akers

Abstract

Study objective: To identify predictors of anticipated pain with intrauterine device (IUD) insertion in adolescents and young women.

Design: We performed linear regression to identify demographic, sexual/gynecologic history, and mood covariates associated with anticipated pain using a visual analogue scale pain score collected as part of a single-blind randomized trial of women who received a 13.5-mg levonorgestrel IUD.

Setting: Three academic family planning clinics in Philadelphia Pennsylvania.

Participants: Ninety-three adolescents and young adult women aged 14-22 years.

Intervention: Participants received either a 1% lidocaine or sham paracervical block.

Main outcome measures: Anticipated pain measured using a visual analogue scale before and perceived pain at 6 time points during the IUD insertion procedure.

Results: Black or African American participants had a median anticipated pain score of 68 (interquartile range [IQR], 52-83), White participants had a median anticipated pain of 51 (IQR, 35-68), whereas participants of other races had a median anticipated pain score of 64 (IQR, 36-73); P = .012. In multivariate analysis, race was the only covariate that significantly predicted anticipated pain at IUD insertion. Women with anticipated pain scores above the median had significantly higher perceived pain during all timepoints of the IUD insertion procedure.

Conclusion: Increased anticipated pain is associated with increased perceived pain with IUD insertion. Black adolescent women experience greater anticipated pain with IUD insertion. This population might benefit from counseling and clinical measures to reduce this barrier to IUD use.

Keywords: Adolescent; Contraceptive devices; Intrauterine devices; Pain.

Conflict of interest statement

Disclosure/Conflict of Interest:

TA Hunter has nothing to disclose. SR Sonalkar has nothing to disclose. CA Schreiber is a consultant for Exeltis Pharmaceuticals and received research funding from Bayer Pharmaceuticals, Medicines360, ContraMed, and NICHD. LK Perriera has nothing to disclose. MD Sammel has nothing to disclose. AY Akers is a consultant for the Merck HPV advisory board and is a member of the Mylan Inc Women’s Health Advisory Board.

Copyright © 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1)
Figure 1)
Anticipated pain of IUD insertion as measured by a 100 mm Visual Analog Scale, stratified by race category. The box represents the interquartile range, the horizontal line represents the median, and diamonds represent the mode. Whiskers represent the scores outside the interquartile range. Circles indicate outliers.
Figure 2)
Figure 2)
Adjusted perceived pain VAS scores (±SE) in women with high and low anticipated pain. High anticipated pain scores were those above the median (red); low anticipated pain scores were those below the median (blue). VAS scores were adjusted for race, age, and randomization group. Difference in VAS scores with P

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Source: PubMed

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