Log in

No account? Create an account

Previous Entry | Next Entry

It comes as no surprise to any one who's had an insertion that there's a disparity between patient and doctor perceived pain, have some research that proves it!

The data came from a double-blind, randomized, placebo-controlled trial of intracervical lidocaine gel, compared with placebo, for relieving pain during IUD insertion; it found no advantage to lidocaine gel. This secondary analysis looked at patient and provider ratings for patient pain on a 100-mm visual analogue scale (VAS), with no pain at 0 mm and worst pain possible at 100 mm.

Abstract here - http://www.contraceptionjournal.org/article/S0010-7824%2812%2900418-0/abstract
(Only the first bit of the study is in the abstract)

The point of maximum pain during the IUD insertion procedure rated a mean score of 64 from patients, compared with a mean rating of 35 from providers. That 29-mm difference was statistically significant, Dr. Karla E. Maguire and her associates reported at the annual meeting of the American College of Obstetricians and Gynecologists.

(From the abstract - Women who received the paracervical block reported a median VAS score of 24.0 mm with IUD insertion, and women who did not receive local anesthetic reported a median VAS score of 62.0 mm with IUD insertion.

My comment - There's a HUGE difference between 24mm and 62mm and yet they say there's no advantage to it???  How is the 29 mm difference above statistically significant but the 38 mm difference in pain between lidocained women and unmedicated insertions of no significance??? This makes no sense.)

Nineteen percent of providers rated patient pain within 10 mm of patients’ ratings. Twenty-three percent of providers gave ratings that were 50 mm or farther apart from patients’ pain ratings, said Dr. Maguire, an ob.gyn. at the University of Miami.

The results will be published in the journal Contraception, she said.

Patients rated pain at four points during the procedure: tenaculum placement; uterine sounding; IUD insertion; and speculum removal. Patients and providers agreed about the timing of maximum pain 41% of the time – a very poor level of agreement, she said.

Uterine sounding was rated the most painful point by 40% of patients and 45% of providers. IUD insertion was rated the most painful point by 36% of patients and 15% of providers. Tenaculum placement was rated the most painful point by 14% of patients and 25% of providers. Speculum removal was rated the most painful point by 10% of patients and 5% of providers. No patients and 8% of providers said patients felt no pain. Three percent of providers (and no patients) wrote in some other point of maximum pain for the procedure instead of answering the multiple-choice question.

Ratings by the midlevel providers were slightly but significantly closer to patient ratings, compared with physician ratings – 7 points closer, on average, Dr. Maguire said. The midlevel providers were no better than were attending physicians, however, in estimating the point of maximum patient pain during the procedure.

The mean age of the patients was 27 years. The cohort was 77% Latina/Hispanic, 13% white, and 10% other races/ethnicities. Thirty percent were nulliparous. Their mean pain score for past episodes of dysmenorrhea was 35. They anticipated a pain rating of 57 for the IUD insertion procedure.

Among the providers, 91 (46%) were physicians, 91 (46%) were nurse practitioners, certified nurse-midwives, or physician assistants, and 18 (9%) were residents. Most (52%) had 11-20 years of experience in IUD insertion, while 26% had 5-10 years of experience, and 22% had less than 5 years of experience.

More links - http://hcp.obgyn.net/conference-insider/acog2012/content/article/1760982/2069921


( 8 comments — Leave a comment )
Jun. 6th, 2013 02:23 am (UTC)
I think part of it could be that they can't see the patients face during the procedure. For my first (paragard) insertion, it hurt a lot but less than I was expecting, and I'm one of those who "grins and bares it" rather than expressing pain and I'm quite good at hiding pain due to my endo.

It is interesting the difference between the sounding and the insertion levels. They were pretty close for me with the paragard, I wish I remembered the mirena but I was knocked out for it.
Jun. 6th, 2013 11:19 pm (UTC)
I was exactly the same, I feel it to be rude to make noises while the doctor is working, so I was extremely quiet despite my pain, but my face definitely showed it!
Jun. 7th, 2013 01:20 am (UTC)
I, on the contrary, definitely used the f-bomb at least one during my insertion! Didn't mean to be rude, the sharp pain of the sounding just took me by surprise, it was completely involuntary. The sound felt like it had a dart for a tip! The doctor was excellent though about talking to me and telling me how to breathe so I could manage pain.

Thanks for sharing this study, divineoubliette!
Jun. 18th, 2013 05:20 am (UTC)
I also swore, and I agree with the 40% of patients who said that the sound was the worst part. That was a pain completely unlike any pain I've had in my life, but it was over quickly and worth it.

Thanks for posting about this study, OP!
Jun. 6th, 2013 05:07 am (UTC)
I would very much like to get a look at the box and whisker plots in the full article, but alas, I don't want to spend $30 on the damn thing. Anyway, I'd like to point out that "different" and "statistically different" are not the same thing. There is a 40ish mm difference between median VAS scores, but we don't know the spread of the scores between the two groups. The p-value is greater than 0.05, which indicates that the groups are statistically similar.
Jun. 6th, 2013 05:15 am (UTC)
Yeah I didn't want to dish the 30$ for the study either, you do raise some good points (some of the same that I was wondering), hopefully the study will be available soon, if it is I will link to it but it may take a while.
Jun. 6th, 2013 05:52 am (UTC)
here it is! http://ge.tt/5ZX0pbi/v/0?c

I promise this is a link to the article, the full 6 pages, but if you don't want to click but are willing to share your email (even your lj email that will go to your real email), please message me and tell me the address you want it sent to and I will send it.
Jun. 6th, 2013 07:24 am (UTC)
You are fantabulous! Mille gratzi!
( 8 comments — Leave a comment )

Latest Month

September 2019


IUD Divas
Powered by LiveJournal.com