Date of Award

Spring 5-2025

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Carr, Kristen

Keywords

intrauterine device, IUD, pain management, oral NSAIDs, topical anesthetic

Abstract

An intrauterine device (IUD) is a highly effective, long-acting reversible contraceptive (LARC) option for patients from menarche until menopause. Despite its effectiveness, pain associated with IUD insertion remains a significant barrier to IUD insertion use. Unrelieved pain during the procedure may lead to serious complications, such as vasovagal shock and cardiac arrhythmias, which may negatively impact patient experience and adherence to contraceptive methods. To this day, there is no standard, effective recommendation for pain management during IUD insertion. This literature review aims to compare the efficacy of oral NSAIDs, which are commonly used due to their nonspecific analgesic property, and topical anesthetics in pain reduction during IUD insertion, considering the differences in mechanism of action and clinical implications. A review of peer-reviewed studies was conducted for oral NSAIDs versus topical anesthetics, such as lidocaine and lidocaine-prilocaine mixtures, throughout different steps of the procedure. A data search of PubMed and Embase was conducted utilizing keywords; 11 studies met final inclusion criteria. Results show that oral NSAIDs, such as ibuprofen and naproxen, are not effective for acute procedural pain during IUD insertion but are effective in post-procedural pain management. Topical anesthetics show greater efficacy in pain reduction for acute procedural pain. Given the limited efficacy of NSAIDs and the targeted pain relief offered by topical anesthetics during IUD insertion, clinicians should prioritize topical anesthetics to improve patient comfort, outcomes, and satisfaction.

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