Differences in pain regimens among nulliparous patients undergoing intrauterine device placement within a single health system.

Abstract

Although offering pain management with intrauterine device placement is recommended, but no standardized protocol exists. Patients may experience disparities pain regimens offered with placement based on where they seek care. This study aimed to describe the pain medication regimens that clinicians use for intrauterine device placement and the patient and clinician factors and clinic settings associated with receiving medication before and during placement. We performed a retrospective study of nulliparous individuals aged 15 to 50 years who had an intrauterine device placed from 2019 to 2021 (N=1153) across a large statewide health system in the Southeast. From the electronic health record, we abstracted exposure variables (ie, patient, clinician, and clinic characteristics) and outcomes (ie, medication regimens used before and during intrauterine device placement). We used bivariate analysis and multivariable logistic regression to examine associations between exposure variables and outcomes. Less than half of the patients (41.7%) received medications before or during intrauterine device placement. Medication regimens used before and during intrauterine device placement varied by clinician specialty, clinician type, and clinic location. After multivariable regression, patients were more likely to receive preinsertion medications if they had a lower body mass index, received the Skyla intrauterine device, were treated by advanced practice providers or clinicians with a specialty in pediatrics or internal medicine, or were seen in >1 clinic visit for their intrauterine device placement (all P<.01). Patients were more likely to receive pain medications during intrauterine device placement if they were younger, treated by internal medicine clinicians, or had their intrauterine device placed on the same day they requested it, and they were less likely to receive medications during placement if seen by advanced practice providers or in a rural setting (all P<.01). There were no differences by patient race or insurance type. We found that pain management with intrauterine device placement is associated with clinician specialty, clinician type, and practice setting, with few significant patient factors. Although no particular pain regimen is universally recommended, several options have been shown to be potentially beneficial for nulliparous patients. Therefore, improving clinician knowledge about effective pain regimens and expanding resources across all clinic settings may improve nulliparous patients' experiences and shared decision-making regarding medication use before and during intrauterine device placement.