A Literature Review on the Use of Analgesia During In-Office Intrauterine Gynecologic Procedures

Abstract

Research Question: Do different pain control methods during in-office gynecologic procedures have significant impact on women¿s perception of pain?

Background and Significance: The conversation surrounding pain control during in-office gynecologic procedures has gained popularity over the last several years as patients share their stories on social media. There is a paucity of information on analgesia use during intrauterine device (IUD) insertions and other gynecologic procedures. There is concern that patients¿ fears surrounding the insertion procedure limits the amount of people who decide on this highly effective method of contraception. The aim of this project is to examine 3 areas impacting the pain control provided during office based gynecologic procedures. The first and largest component is what literature is available on patients¿ perceptions of pain with and without analgesia for intrauterine procedures. The second area explored is the health care providers perception of the procedure with and without analgesia. The third area of exploration is how patient perceptions and shared decision making regarding the types of pain control offered during obstetrical or gynecological procedures impacts the long-term relationship between provider and patients.

Materials and Methods: A literature search was conducted to find scholarly articles on different types of analgesia studied for IUD insertion and similar intrauterine gynecologic procedures including hysteroscopy, balloon catheterization, as well as tenaculum use. Exclusion criteria was OB/GYN procedures that cannot be performed in-office.

Results: Aim 1: The available literature on different methods of analgesia for office-based gynecologic procedures is sparse and inconclusive. Some small trials have been executed to find pain control options that might provide relief for patients but repeat studies with a larger patient sample and controls would be needed to draw conclusive data on which methods work best. While some studies endorsed pain relief from cervical block, paracervical block, topical or oral analgesia agents, other studies refuted the benefits of each of these methods. Aim 2: Minimal studies are available on the perceived benefit to the provider when using analgesia for office-based gynecologic procedures. One qualitative study discussed the increase ease of procedure and ease of sample obtainment by the provider. Aim 3: The available literature on shared decision making and the impact of social media on patient preferences showed that most of the available patient-created content surrounding IUD placement is negative. Studies on shared decision making showed higher levels of patient satisfaction with their care when given decision making tools.

Conclusion: Of the available literature on the efficacy of analgesia during office based gynecologic procedures, most of the studies were small, low-powered, single site trials that concluded with the need for repeat studies to be completed for conclusive recommendations to be determined. Although some methods showed improved pain scores by patients, no method is universally used by providers who perform these procedures which can cause frustration for these patients and a mistrust in the medical system. Patient decision making might be impacted if they feel they are not being adequately counselled or offered acceptable treatment options by their providers. While further, high-powered studies need to be conducted to arrive at a pain management consensus on this front, patient desires and attitudes should not be ignored.