Verbal Analgesia Is As Good As Oral Tramadol Prior to Intrauterine Device Insertion Among Nulliparous Women: A Randomized Controlled Trial

Abstract

Study Objective To evaluate pain management strategies during insertion of intrauterine device (IUD) among nulliparous women as compared to the analgesic effects of oral tramadol and 'verbal analgesia' on pain relief. Design We conducted a randomized controlled trial from December 2015 to December 2018. Setting A multi-center outpatient clinics. Patients or Participants 54 nulliparous women. Interventions Patients who underwent Levonorgestrel-releasing intrauterine device (IUD) insertion were randomized for analgesic treatment or 'verbal analgesia' prior the IUD insertion. Measurements and Main Results All the patients were Caucasian. There was no difference between the two groups regarding gravidity, age, smoking or body mass index (BMI). No significant differences were detected between the groups on the procedure manner including ease of insertion (p=.415), number of insertion attempts (p=.514) and complicating events during the insertion (p=.150). Mean level of pain by VAS was 4.5±1.6 (2-8) for the tramadol group and 4.8±2.4 (0-10) for the verbal analgesia group. There was no spontaneous ejection of the IUD in either group, no case of endometritis, or discomfort that resulted in IUD removal. Conclusion There was no benefit for pain analgesia prior to the insertion of a IUD in nulliparous women. Verbal analgesia can be a suitable tool for this process and clinicians should become more familiar with its use.