Effective Pharmacologic Pain Management Interventions for Intrauterine Device Insertion: A Systematic Review and Network Meta-Analysis

Background To identify the most effective pain management intervention during intrauterine device (IUD) insertion based on recent clinical trials in the United States. Methods An electronic search was conducted in the following databases and registry for studies conducted in the United States: Medline via PubMed, SCOPUS, and Clinicaltrials.gov. Data collection occurred between February 7th, 2024, to March 3rd, 2024. Examination of 16 studies, involving 1,524 individuals was utilized in this meta-analysis. Selection criteria included Randomized Controlled Trials (RCT) conducted in the United States, biological women receiving IUDs at the age of 18 years or older, trials comparing treatments to placebo or no treatment, and trials that used the Visual Analogue Scale (VAS) for pain scores. A standard Google Sheets spreadsheet was used to perform data entry. The present review was designed according to the PRISMA guidelines for reporting of systematic reviews incorporating network meta-analyses of health care interventions and was submitted to PROSPERO accordingly (identifier: CRD42024534207). Results We utilized the JADAD scoring guidelines to determine risk of bias assessment through two different reviewers. Network meta-analysis using a random effect model was performed to compare the various pharmacological interventions. The results of the comparison were presented in forest plots and league tables using P-scores and mean differences with 95% confidence intervals. Heterogeneity among studies was assessed by the I² statistic and Cochran’s Q test, and random-effect univariate meta-regression was conducted to explore the source of heterogeneity. Among the four different substances studied, only paracervical lidocaine was significant in producing lower VAS pain scores related to intrauterine device insertion as opposed to placebo (mean difference: -14.6; 95% confidence interval: -27.5, -1.7) and as opposed to oral misoprostol (mean difference: -25.8; 95% confidence interval: -43.8, -7.7). Conclusion Paracervical lidocaine showed the greatest reduction in VAS pain scores during IUD insertion, thus supporting that paracervical lidocaine may be used as a pain management option for future intrauterine device implantation. Future studies should focus on clinical trials utilizing a consistent VAS pain scale and targeting specific subpopulations. Trial Registration: This review has been registered on May 2024 through Prospero with the identifier number: CRD42024534207.