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TOPLINE
Active transcutaneous electrical nerve stimulation (TENS) provided no pain relief in participants during the insertion of an intrauterine device (IUD) compared with sham TENS. Participants without prior births reported higher pain levels than those with prior births.
METHODOLOGY
- Researchers conducted a randomized controlled trial to assess the use of TENS as an intervention for reducing pain among participants undergoing IUD insertion.
- They included 98 adult participants (median age, 29 years) undergoing levonorgestrel 52 mg or copper 380 mm2 IUD insertion at the Mount Sinai Medical System (March 2024 to April 2025) or Yale New Haven Health System (from January 2025 to April 2025).
- Participants were randomly assigned to receive either active high-frequency TENS at 80 Hz, with pads placed at the lower abdomen and lower back (n = 48), or sham TENS, with pads placed but no electrical stimulation provided (n = 50), during the procedure.
- Participants received 600-800 mg oral ibuprofen before the procedure, and disposable hot packs for the lower abdomen were offered afterward; 98% of participants had transabdominal ultrasound guidance during insertion.
- Pain was measured using a 100-mm visual analog scale at multiple timepoints, with the primary outcome being mean pain scores during the insertion of an IUD. Overall, 46.9% of participants were nulliparous.
TAKEAWAY
- Mean pain scores during the insertion of an IUD did not differ between active and sham TENS groups (50.8 vs 50.6 mm; P = .97).
- Nulliparous participants reported significantly higher scores for pain than parous participants (mean, 59.1 vs 43.3 mm; P = .005), but no difference was observed between TENS-exposed and unexposed groups among nulliparous (58.8 vs 59.3 mm; P = .95) and parous (43.5 vs 43.2 mm; P = .97) participants.
- Maximum pain scores estimated by clinicians were lower than those reported by participants (mean, 48.9 vs 60.5 mm; P < .001).
- Participants with clinician-perceived difficult IUD insertions reported significantly higher mean maximum pain scores than those with clinician-perceived easy insertions (71.6 vs 56.0 mm; P = .006). The TENS group was more likely to recommend the treatment to a friend than the sham group (91.7% vs 76.0%; P = .04).
IN PRACTICE
"While this trial did not demonstrate the benefit of TENS for reducing pain during IUD insertion, it also found no evidence of harm, supporting its safety in this context," the authors wrote. "Our findings suggest that successful pain management during IUD insertion may depend on a combination of factors, including operator experience, procedure duration, and adjuncts like ultrasound, rather than any single intervention. It remains possible that TENS could provide benefit in settings with fewer pain management options or among specific populations," they added.
SOURCE
The study was led by Lauren H. Kus, MD, MSCR, of the Division of Complex Family Planning in the Department of Obstetrics, Gynecology and Reproductive Science at Icahn School of Medicine at Mount Sinai in New York City. It was published online on October 8 in the American Journal of Obstetrics and Gynecology.
LIMITATIONS
The study did not evaluate smaller devices but only levonorgestrel 52 mg and copper 380 mm2 IUDs. Participants presenting for removal and reinsertion of IUD were excluded.
DISCLOSURES
The study was supported by grants from the Society of Family Planning. The authors reported no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
