FPIN's Help Desk Answers
Pain Medications Before IUD Placement
Am Fam Physician. 2020 Jan 15;101(2):119-120.
Do preprocedure medications affect the pain of intrauterine device (IUD) insertion?
Topical lidocaine preparations including gels, creams, and sprays may modestly decrease pain with tenaculum placement but not during IUD insertion. (Strength of Recommendation [SOR]: A, based on a meta-analysis of randomized controlled trials [RCTs].) The use of a paracervical block with unbuffered lidocaine does not decrease pain with either step. (SOR: A, based on a meta-analysis of RCTs.) However, a paracervical block using buffered lidocaine may decrease pain with uterine sounding and IUD placement, as well as overall pain. (SOR: B, based on an RCT.) Tramadol and naproxen decrease pain with IUD placement. (SOR: A, based on a meta-analysis of RCTs.)
A 2018 meta-analysis of 11 RCTs (N = 1,458) evaluated the effects of a paracervical lidocaine block or application of lidocaine to the genital mucosa before IUD insertion in nulliparous and parous women.1 Copper IUDs and the levonorgestrel-releasing intrauterine system (Mirena) were used. Pain was assessed using a 0- to 10-point visual analog scale, with higher numbers indicating more pain. A lidocaine preparation of 2.5% gel (three trials) or 2.5% cream (one trial), or a combination of 2.5% lidocaine and 2.5% prilocaine cream (two trials) was applied to the ectocervix, in the cervical canal, or both. Lidocaine 10% spray (two trials) was applied as four pumps (40 mg) to the ectocervix, and paracervical blocks (four trials) were performed as unbuffered 1% lidocaine injections on either side of the cervix and at the tenaculum site. Control interventions were placebo or no intervention. As a group, genital mucosa lidocaine applications reduced pain with tenaculum placement (six trials; n = 764; mean difference [MD] = −1.0; 95% CI, −1.9 to−0.09) compared with placebo or no intervention, but there was no significant difference with IUD insertion (seven trials; n = 828; MD = −1.0; 95% CI, −2.0 to 0.01). There was
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1. Perez-Lopez FR, Martinez-Dominguez SJ, Perez-Roncero GR, et al. Uterine or paracervical lidocaine application for pain control during intrauterine contraceptive device insertion: a meta-analysis of randomized controlled trials. Eur J Contracept Reprod Health Care. 2018;23(3):207–217.
2. Mody SK, Farala JP, Jimenez B, et al. Paracervical block for intrauterine device placement among nulliparous women. Obstet Gynecol. 2018;132(3):575–582.
3. Lopez LM, Bernholc A, Zeng Y, et al. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev. 2015;(7):CD007373.
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