Pain and pain relief with intrauterine device insertion

Comment on ‘Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives’

“…The authors quoting a Cochrane Review3 say that “pharmacological strategies” fail to show “clear evidence that pain is significantly reduced during or after routine IUC placement”. Yet two double-blind randomised studies2 4 were not evaluated, totalling 190 women.…”

“…With tolfenamic acid 200 mg three times a day started post-insertion, significantly reduced ( p <0.01) spasmodic pain was reported in the subsequent 24 hours4; and measured by visual analogue scales (VAS), there was significant post-insertion pain reduction at 10 minutes with mefenamic acid 500 mg given 60 minutes pre-insertion 2. Moreover, the “absence of proof” from other good studies cited in the Cochrane Review3 cannot be “proof of absence” of benefit by non-steroidal anti-inflammatory drugs (NSAIDS) for prostaglandin-related pain.…”