Priority 26 from the Contraception PSP
|UNCERTAINTY: What methods of pain relief are effective during intrauterine contraceptive insertion (oral analgesia, local anaesthetic gel, spray or injection)? (JLA PSP Priority 26)|
|JLA question ID||0049/26|
|Explanatory note||176 thousand IUCs were inserted in England in 2013-4, it is more popular in older women and pain is reduced for women who have had a vaginal birth. The systematic review included RCTs of any intervention given prior to, or during, IUC insertion in order to reduce pain. Outcome- patient reported pain. Found: naproxen may decrease pain during IUC insertion, Misoprostol did not help and may even increase pain. Lidocaine 2% gel showed no effect, other lidocaine formulations may help including 4% topical gel, 10% spray, lidocaine and prilocaine cream, and 1% paracervical block. Effective analgesia during insertion is likely to increase the acceptability and uptake of the method.|
Interventions for pain with intrauterine device insertion. Laureen M Lopez, Alissa Bernholc, Yanwu Zeng, Rebecca H Allen, Deborah Bartz, Paul A O'Brien, David Hubacher. CDSR July 2015
FSRH IUC Guideline Oct 2015 (page 21-22: 10.4 Interventions to ease IUC insertions. Suggests women who have not been pregnant or had a vaginal birth, who are older/perimenopausal may experience more pain. Recommends - “research is required to fully evaluate the use of LA cervical block for straightforward IUC insertion”.
|Extra information provided by this PSP|
|Original uncertainty examples||
What is effective analgesia for IUC fitting? (HCP) ~ “Research on how to make IUD insertions less painful and proddy would be amazing” (Patient).
|Submitted by||Healthcare Professionals x 3~Patients x 2~Both x 0|
|PSP unique ID||0049|
|Total number of uncertainties identified by this PSP.||57 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)|
|Date of priority setting workshop||21 April 2017|