title: Interventions for pain with intrauterine device insertion.
abstract: BACKGROUND
  Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol.
  
  
  OBJECTIVE
  To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain.
  
  
  METHODS
  We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials.
  
  
  METHODS
  We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention.
  
  
  METHODS
  Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed.
  
  
  RESULTS
  Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion.
  
  
  CONCLUSIONS
  No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.
authors: Department of Obstetrics and Gynecology, Women and Infants' Hospital, 101 Dudley Street, Providence, Rhode Island, 02905, USA.
authors: Rebecca H
authors: RH
authors: Allen
authors: Deborah
authors: D
authors: Bartz
authors: David A
authors: DA
authors: Grimes
authors: David
authors: D
authors: Hubacher
authors: Paul
authors: P
authors: O'Brien
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007434:Intrauterine Devices / Q000009:adverse effects*; D016595:Misoprostol / Q000627:therapeutic use; D009288:Naproxen / Q000627:therapeutic use; D010120:Oxytocics / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010120:Oxytocics; D016595:Misoprostol; D009288:Naproxen; D007052:Ibuprofen