Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not prophylactic medication reduces intrauterine device (IUD) insertion pain in women of childbearing age.

STUDY DESIGN: Review of 3 English language trials: a randomized controlled trial, double-blinded randomized control trial, and a double-blinded randomized placebo controlled trial.

DATA SOURCES: A randomized controlled trial, double-blinded randomized control trial, and a double-blinded randomized placebo controlled trial comparing the prophylactic medications: lidocaine and mistoprostol or placebo group. All articles were found using Medline, PubMed, and OVID.

OUTCOMES MEASURED: Reduction of pain with IUD insertion was compared between mistoprostol or lidocaine for the prophylactic treatment of IUD pain insertion via visual analog scale (VAS) by patient self-report; a 10-point pain scale was used to assess pain during IUD insertion; 100-mm visual analog scale (VAS) at several time points rating their pain during the procedure. Secondary outcomes measured included: provider “ease of placement”, side effects and IUD retention after 1 month.

RESULTS: One randomized control trial, one double-blinded randomized control trial, and one double-blinded randomized placebo controlled trial were included in this review. None of the prophylactic medications were shown to reduce intrauterine device (IUD) insertion pain in women of childbearing age.

CONCLUSIONS: The results of the three randomized controlled trials did not demonstrate that prophylactic medication using mistoprostol, endocervical lidocaine, or lidocaine paracervical block reduce pain with insertion of intrauterine devices (IUDs). Thus far all methods used to try to treat IUD insertion pain have not shown significant improvement in patient pain scores. Currently there are no recommendations for best practice to relieve pain associated with IUD insertion, but ibuprofen, mistoprostol, & lidocaine are being utilized at this time, but have not proven effective. IUD’s are one of the most effective, safe, and cheapest forms of long-term birth control. IUD’s are underutilized in the U.S compared to Europe, which has been credited to the discomfort experienced during IUD placement. The hope is that with improved patient satisfaction and decreased pain with IUD insertion that this form of birth control will be utilized more.

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