Preliminary Baseline Findings of the CALM (Comfort, Assurance, Language Model) Approach [37A

Abstract

INTRODUCTION: Concerns about pain during IUC insertion are common among women and limit acceptability of IUCs. This study evaluates pain associated with IUC insertion prior to CALM intervention implementation (presence of a support person dedicated to patient comfort, enhanced assurance, scripted gentle language). METHODS: Women ages 18-53 seeking IUC insertion were recruited for participation at two clinic sites. There are 110 women in the control group receiving standard of care procedures. We calculated mean VAS Pain Scores from a Pain Sensitivity Questionnaire, 2 pre-insertion scales, 5 time points during the procedure and overall, and 2 post-procedure scales. We calculated t-tests for binary variables, ANOVA for categorical variables, and linear regression for continuous variables. RESULTS: Participants received 77 Mirena and 32 Paragard IUCs. VAS scores were M= 32.2mm for pain sensitivity, M= 48.0mm for pain expected, M=49.7mm for post procedure pain, M= 51.7mm for entire procedure pain, and M= 53.8mm for IUC insertion pain. There was a moderately significant difference in post procedure pain means between parous and nulliparous women (p-val = 0.05) and provider reported procedure difficulty (p-val=0.07). Pain sensitivity mean and pain level during period significantly predicted post procedure pain (p-val < 0.0001). CONCLUSION: Nulliparous women had a greater mean VAS pain score than parous women, and more difficult provider experience had a greater mean VAS pain score. There is a linear relationship between both period pain and pain sensitivity with post procedure pain. This may allow us to identify those most at risk for painful IUC insertion.