Differences in Pain Regimens Among Nulliparous Patients Undergoing Intrauterine Device Placement Within a Single Health System

( Am J Obstet Gynecol 2025;233:297.e1–e12. doi: 10.1016/j.ajog.2025.03.021) The placement of an intrauterine device (IUD) is a safe, common, and reliable procedure for contraception; fear of pain during the procedure is often a deterrent for patients who would otherwise choose an IUD, particularly for patients who are nulliparous. Recent media such as press coverage and social media have emphasized painful, negative, and some traumatic experiences during IUD placement, and many patients are advocating for better options for pain management and support from clinicians during the procedure. Many pain relief regimens have been proposed and there is a lack of consistent evidence as to which are the safest and most effective regimens, and if these differ between nulliparous and multiparous women. This study was designed to evaluate differences in pain medication regimens in a statewide health system in nulliparous patients, with emphasis on identifying patient and clinician factors influencing differences in receiving medication before or during IUD placement.