LI4 Acupuncture for Analgesia in Intrauterine Device Insertion
Condition: IUD Insertion Complication; Acute Pain
MeSH terms: Acute Pain
Study type: Interventional

Summary: 
      Pain during IUD insertion is substantially psychologic in origin, responds extremely well to
      non-pharmacologic interventions. Considering the fact that acupuncture is a modality exerting
      both psychologic and physiologic effects, the authors presume that acupuncture administration
      before IUD insertion may have positive effects on pain control. From this point of view, the
      aim of this study to investigate the effects of LI4 acupuncture administered shortly before
      IUD insertion on pain perception and discomfort of the women.
    

Detailed description: 
      Intrauterine devices (IUDs) are one the most preferred, most effective and reversible
      contraceptive methods with long term effects. The major drawback of women for IUD use is the
      pain anticipation during insertion of the device.

      Studies using visual analog scale (VAS) demonstrated that pain perception during IUD
      insertion varied between 2-7 score. Surprisingly there are only limited number of studies on
      pain management during IUD insertion which is an ambulatory and out-patient gynecologic
      procedure. Besides the results of present studies contradict with each other. As a result, a
      standardized protocol is lacking for pain management in IUD insertion [1]. Currently, most of
      the IUDs are administered in Community Health Centers (CHC) in our country and no modality
      for pain control is applied before or after IUD insertion. In case of necessity intramuscular
      or oral analgesic drugs are prescribed.

      In a long-standing review on the basics of this issue, it is concluded that the cervical
      component of pain perception during IUD insertion is psychologic rather than pathologic, is
      un-responsive to oral non-steroidal anti-inflammatory drugs and could be deducted via
      psyche-prophylactic methods. similar results were presented with studies undertaken In the
      advancing years. A recent study demonstrated that verbal inspiration techniques were as
      effective as oral tramadol for pain management in IUD insertion. Additionally, the effects of
      anticipation of pain on perception of pain is essential as well. Because in a large scale
      study, the results showed that one point increments in the VAS for anticipated pain resulted
      in an increase of pain perception by 19,7%. Therefore, the fact that psychologic, biologic,
      cognitive, behavioral, emotional and social factors interfere with pain perception is
      well-known and it is recommended by clinicians that these factors should be taken into
      consideration in processes of selecting modalities for pain management.

      Scientists research for the mechanism of pain control that acupuncture provides. Acupuncture
      is extremely effective in autonomic nerve regulation. Also, crucial effects of afferent
      information within somatic nerve fibers on autonomic functions were demonstrated on
      experimental and clinical studies. Acupuncture relies on biology based physiologic and
      psychologic mechanisms. It causes both the secretion of oxytocin and endogen opioids that
      induce functional changes in various organ systems and rhythmic changes in vulnerable tissues
      via the stimulation of receptors or nerve fibers.

      Acupoint LI4 is the most intensely studied, hte most preferred for analgesia and is the most
      used acupoint in routine daily practice. Studies on pain management in cases of chest tube
      pain, dental pain or multiple sclerosis were undertaken using LI4.
    

Intervention name(s): Acupuncture
Intervention type(s): Procedure
Intervention description(s): LI4 is located on the dorsum of the hand, midway between the 1st and 2nd metacarpal bones, approximately in the middle of the 2nd metacarpal bone on the radial side. Acupuncture is practiced by using 0,25x25mm sized needles. LI4 point is punctured perpendicularly 2cm in the direction of the palm center.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Case-controlled
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: IUD insertion; Acupuncture; Pain management; Acute pain