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Contraceptive Pearl: Non-Pharmacologic Options for Pain Control with Intrauterine Device Insertion

Written by Angeline Ti, MD, MPH

The experience of pain combines cognitive, emotional, and sensory components, and is often a complex interaction between a person’s past experiences, current state of mind, and what nerves are being irritated. While there are a variety of pharmacologic options for pain control with IUD insertions, there are also non-pharmacologic methods that may help reduce pain during gynecologic procedures.

Distraction can be helpful during gynecologic procedures. Verbal distraction, or “vocal local,” can include guided imagery, positive suggestion, or simply small talk. While this can come from the provider, a doula, or other clinic staff, allowing the patient to choose a support person to be present for the procedure can be helpful. Offering music as a distraction can be helpful too, though one study that implemented music via headphones during first-trimester abortion found a small increase in pain compared to the control group, so it is important to keep verbal communication as an option. Visual distraction can also be helpful: one study found a 54% reduction in pain scores during colposcopy after ceiling art was installed.

Integrative methods may be helpful for patients. Aromatherapy may help some patients with anxiety: two small studies looking at inhaled lavender with IUD insertion and intrauterine insemination found reductions in anxiety during the procedures, but no change in pain scores. The evidence around acupuncture for gynecologic procedures is mixed, but may be helpful. A systematic review found adjunctive acupuncture to significantly improve pain during and after oocyte retrieval, and a randomized control trial of auricular acupuncture during first-trimester aspiration abortion found a significant reduction in both pain and anxiety. Though, a similar study of auricular acupuncture, acupressure, and placebo found no significant benefits.

While the evidence base for non-pharmacologic interventions is small or extrapolated from other gynecologic procedures, given the low-risk nature of these interventions and the potential for benefit, it’s important to employ multi-modal options for pain control to be able to individualize care and better meet your patients’ needs.


Resources:

Your Birth Control Choices Fact Sheet

Your Birth Control Choices Poster

IUD Fact Sheet


Sources:

Guerrero JM, Castaño PM, Schmidt EO, Rosario L, Westhoff CL. Music as an auxiliary analgesic during first-trimester surgical abortion: a randomized controlled trial. Contraception. 2012;86(2):157-162. doi:10.1016/j.contraception.2011.11.017

Carwile JL, Feldman S, Johnson NR. Use of a simple visual distraction to reduce pain and anxiety in patients undergoing colposcopy. J Low Genit Tract Dis. 2014;18(4):317-321. doi:10.1097/LGT.0000000000000024

Shahnazi M, Nikjoo R, Yavarikia P, Mohammad-Alizadeh-Charandabi S. Inhaled lavender effect on anxiety and pain caused from intrauterine device insertion. J Caring Sci. 2012;1(4):255-261. Published 2012 Nov 28. doi:10.5681/jcs.2012.035

Jones T, Purdy M, Stewart EA, et al. Lavender Aromatherapy to Reduce Anxiety During Intrauterine Insemination: A Randomized Controlled Trial. Glob Adv Health Med. 2021;10:21649561211059074. Published 2021 Nov 17. doi:10.1177/21649561211059074

Liu LY, Tian ZL, Zhu FT, et al. Systematic Review and Meta-Analysis of Acupuncture for Pain Management in Women Undergoing Transvaginal Oocyte Retrieval. J Pain Res. 2021;14:2833-2849. Published 2021 Sep 9. doi:10.2147/JPR.S319923

Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL. Auricular acupuncture as an adjunct for pain management during first-trimester abortion: a randomized, double-blinded, three-arm trial. Contraception. 2019;99(3):143-147. doi:10.1016/j.contraception.2018.11.016

Oviedo JD, Marquez E, Gold MA, Westhoff CL. Auricular acupressure and auricular acupuncture as an adjunct for pain management during first-trimester aspiration abortion: A randomized, double-blinded, three-arm trial. Contraception. 2021;103(5):342-347. doi:10.1016/j.contraception.2021.02.005


Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.