What are the recommended pain medications for pre IUD (Intrauterine Device) insertion?

Pain Management for IUD Insertion

Naproxen sodium 500mg taken prior to IUD insertion is recommended for pain management, as it shows significant reduction in post-IUD insertion pain compared to ibuprofen or placebo. 1

Pharmacological Options for Pain Management

NSAIDs

• Naproxen sodium 500mg: Most effective NSAID option, showing significant reduction in post-IUD insertion pain (p=0.01) 1
• Ibuprofen 800mg: Currently commonly recommended but research shows it does not significantly reduce pain with IUD insertion compared to placebo 2, 3
• Timing: Take medication 30-45 minutes before the procedure 2

Lidocaine Preparations

• Lidocaine 1% paracervical block: Effective for reducing pain during cervical grasping (p=0.002) and IUD insertion (p=0.005) compared to control groups 1
• Lidocaine-prilocaine cream: Shows lower mean pain scores during insertion compared to placebo 3, 4
• 10% lidocaine spray: Effective for pain reduction in parous women 3, 4

Other Medications

• Tramadol 50mg: Shows lower mean pain scores for IUD insertion compared to naproxen 550mg in multiparous women 3, 4

Pain Differences by Patient Population

• Nulliparous vs. Parous: Nulliparous women report approximately 17.5mm higher pain scores on visual analog scale than parous women (p=0.004) 2
• Medication effectiveness varies by population:
  • For nulliparous women: Topical 4% lidocaine formulations show better pain control 3
  • For multiparous women: Naproxen and tramadol are more effective 3

Non-Pharmacological Approaches

• Verbal analgesia: Provider using calm, soothing voice and slow speech to put patient at ease 1, 4
• Distraction techniques: Music or television during procedure 4
• Valsalva maneuver: Can be used instead of tenaculum during insertion 4
• Heating pad: Application during procedure may help reduce discomfort 4

Prophylactic Antibiotics

• Prophylactic antibiotics are generally not recommended for IUD insertion 5
• A meta-analysis showed prophylaxis reduced frequency of unscheduled return visits but did not significantly reduce PID incidence or premature IUD discontinuation 5

Common Pitfalls and Caveats

1. Ineffective pain management: Relying solely on ibuprofen, which has been shown to be ineffective compared to placebo 2, 3

2. Misoprostol use: Despite being sometimes used for cervical preparation, misoprostol may actually increase pain during and after insertion compared to placebo 3

   • Associated with more cramping (OR 2.64,95% CI 1.46 to 4.76) 3
   • Higher pain scores before leaving the clinic in nulliparous women 3
   • Side effects include shivering, headache, and abdominal pain 3

3. Failing to prepare patients: Lack of pre-procedure counseling about expected sensations can increase anxiety and perceived pain 4

4. One-size-fits-all approach: Pain management should consider parity status, as nulliparous women experience significantly more pain than parous women 2

Follow-up Recommendations

• No routine follow-up visit is required after IUD insertion 5
• Advise patients to return if they experience side effects, problems, or want to change or remove the contraceptive method 5
• At routine visits, assess satisfaction with the method and address any concerns about method use 5