Effect of oral ketoprofen on pain perception during copper IUD insertion among parous women: A randomized double-blind controlled trial

Efficacy of NSAIDs in reducing pain during intrauterine device Insertion: A systematic review

BACKGROUND

Intrauterine devices (IUD) are highly effective, but insertion pain deters many. While no consensus exists on gold standard analgesia, practitioners commonly recommend over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). This systematic review evaluates NSAID efficacy for pain reduction during IUD insertion.

METHODS

We searched PubMed, Embase, Web of Science, Scopus and Cochrane Library using (intrauterine device* OR IUD*) AND (NSAIDs OR non-steroidal anti-inflammatory drugs). The primary outcome was patient-reported pain during IUD insertion. The authors evaluated each publication for bias using the Centre for Evidenced-Based Medine Critical Appraisal Tool for Randomised Control Trials (CEBM).

RESULTS

The search yielded 6,529 studies, retrieving 29 full texts, with 20 meeting inclusion criteria. This review found limited evidence that prophylactic NSAIDs provide clinically significant pain relief for most women. The review included various NSAID types and dosages. Six studies demonstrated a statistically significant reduction in pain (p < 0.05) compared to placebo.

CONCLUSION

Prophylactic NSAIDs show limited efficacy in reducing IUD insertion pain, with 70 % of studies reporting no significant benefit. These findings, suggesting lower overall effectiveness than previous research, underscore the need for standardized approaches and further research into meaningful pain relief. Heterogeneity in NSAID types, dosages, and pain assessment methods highlights the need for targeted research to improve patient-centered reproductive healthcare.

Strategies to Mitigate Anxiety and Pain in Intrauterine Device Insertion: A Systematic Review

One barrier to the use of intrauterine devices (IUDs) as a contraceptive method is the experience of anxiety and pain during the insertion procedure. Previous reviews have focused on pharmacological methods used to relieve pain during IUD insertion; however, few similar reviews have examined non-pharmacological methods to relieve pain or strategies to reduce anxiety. The objectives of this study were to identify and categorize strategies for reducing anxiety and pain with respect to IUD insertion and the ways in which anxiety and pain were assessed. In particular, the study aimed to identify non-pharmacological interventions and studies that included anxiety as a research outcome. A literature search was conducted of all English-language studies between inception and the week of July 29, 2018 from the following online databases: Medline, Embase, Cochrane Library, and PubMed. The search revealed 426 studies after removal of duplicates, 35 of which fulfilled the inclusion criteria. A total of 29 studies were identified as assessing pharmacological interventions for the management of pain, and six studies assessed non-pharmacological interventions. Only one study included a measurement of patient anxiety during the procedure as an outcome measure. Research on non-pharmacological interventions for the management of anxiety and pain during IUD insertion is lacking. This review found that evidence for the studied pharmacological interventions is conflicting, and there is very little evidence on understanding the effectiveness of strategies to manage anxiety during the IUD insertion procedure. Further high-quality research on non-pharmacological pain and anxiety management strategies is warranted.