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

• Published in: BMJ sexual & reproductive health Vol. 40; no. 2; pp. 150 - 151
• Main Author: Guillebaud, John
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2014
• Subjects: Birth control; Female; Humans; Intrauterine Devices - adverse effects; Pain management; Pain Management - methods; Pelvic Pain - etiology; Pelvic Pain - prevention & control; Side effects; Womens health; intrauterine systems; family planning service provision; intrauterine devices
• ISSN: 1471-1893; 2515-1991; 2045-2098; 2515-2009
• DOI: 10.1136/jfprhc-2014-100904

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 hours 4 ; 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 Review 3 cannot be "proof of absence" of benefit by non-steroidal anti-inflammatory drugs (NSAIDS) for prostaglandin-related pain. Robinson et al. 5 reported in a double-blind randomised controlled trial that hysterosalpingography subjects receiving a 1% lidocaine cervical block totalling 6 ml had significantly less pain (p<0.001) measured by VAS from tenaculum placement, compared with a placebo intracervical saline injection group and a no-injection group.