Priority 26 from the Contraception PSP

UNCERTAINTY: What methods of pain relief are effective during intrauterine contraceptive insertion (oral analgesia, local anaesthetic gel, spray or injection)? (JLA PSP Priority 26)
Overall ranking	26
JLA question ID	0049/26
Explanatory note	176 thousand IUCs were inserted in England in 2013-4, it is more popular in older women and pain is reduced for women who have had a vaginal birth. The systematic review included RCTs of any intervention given prior to, or during, IUC insertion in order to reduce pain. Outcome- patient reported pain. Found: naproxen may decrease pain during IUC insertion, Misoprostol did not help and may even increase pain. Lidocaine 2% gel showed no effect, other lidocaine formulations may help including 4% topical gel, 10% spray, lidocaine and prilocaine cream, and 1% paracervical block. Effective analgesia during insertion is likely to increase the acceptability and uptake of the method.
Evidence	Interventions for pain with intrauterine device insertion. Laureen M Lopez, Alissa Bernholc, Yanwu Zeng, Rebecca H Allen, Deborah Bartz, Paul A O'Brien, David Hubacher. CDSR July 2015 FSRH IUC Guideline Oct 2015 (page 21-22: 10.4 Interventions to ease IUC insertions. Suggests women who have not been pregnant or had a vaginal birth, who are older/perimenopausal may experience more pain. Recommends - “research is required to fully evaluate the use of LA cervical block for straightforward IUC insertion”.

Extra information provided by this PSP
Original uncertainty examples	What is effective analgesia for IUC fitting? (HCP) ~ “Research on how to make IUD insertions less painful and proddy would be amazing” (Patient).
Submitted by	Healthcare Professionals x 3~Patients x 2~Both x 0

PSP information
PSP unique ID	0049
PSP name	Contraception
Total number of uncertainties identified by this PSP.	57 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 April 2017