42. The Effect of Non-pharmacologic Interventions on Pain and Anxiety During IUD and Contraceptive Implant Insertions in Young Women

Abstract

<h3>Background</h3> Intrauterine devices (IUDs) and the contraceptive implant are long acting reversible contraception (LARC) methods commonly used by adolescents. Gynecology visits and insertion of LARC devices can provoke anxiety and pain for adolescents. Research on non-pharmacological interventions for management of adolescent anxiety and pain and is lacking; we aimed to determine the impact of non-pharmacologic interventions on patient reported pain and anxiety during office LARC insertions. <h3>Methods</h3> Patients undergoing an office LARC insertion were eligible. After IRB approval, a systematic controlled trial was conducted; allocating patients to an intervention group (aromatherapy, Buzzy Bee device, aromatherapy + Buzzy Bee device, nursing bedside support) using an alternating sequence. Three outcome variables were analyzed: self-reported pain scores and responses to 2 survey questions (regarding perceived effectiveness of the intervention on pain and anxiety). Numeric data was summarized using medians/IQRs and categorical data as frequency/percent. Chi-squared tests were used to detect differences by group in categorical variables and Kruskal-Wallis tests in continuous variables. A linear mixed effects model determined pain score association with age, time, procedure, and intervention. Proportional odds ordinal regression models were used for survey questions (age, procedure, intervention as possible predictor variables). <h3>Results</h3> 58%) underwent IUD insertion. Intervention groups were roughly equal in size. After adjusting for age, procedure, and time, we found no evidence for an effect of intervention on pain scores [(χ]_3^2=1.7,p=0.64). Variability in pain scores was driven by time point and procedure. Nexplanon insertions had lower pain scores throughout compared to IUD insertions. There was little evidence of an effect of intervention on the pain effectiveness survey question (χ_3^2=4.1,p=0.25) or anxiety effectiveness survey question after controlling for age and procedure (χ_3^2=2.5,p=0.47). However, the effect of procedure was significant in both models (pain: p=0.01, anxiety: p=0.05). <h3>Conclusions</h3> IUD insertion was more painful than Nexplanon insertion regardless of age; this may impact preprocedural counseling. When controlling for age and procedure, pain scores did not differ among intervention groups. The value of bedside nursing support cannot be underestimated. Ongoing research regarding non-pharmacologic interventions is needed to help minimize patient anxiety/discomfort and increase acceptability of office gynecologic procedures.