New guidelines call for more pain management options at gynecology appointments
Women should be given more options for pain management at gynecological appointments, according to first-of-its-kind guidance set forth by the national organization that sets practice standards for physicians.
The American College of Obstetricians and Gynecologists on Thursday released new guidelines for physicians when it comes to better treating pain during common in-office procedures including intrauterine device insertion, endometrial biopsy, hysteroscopy, intrauterine imaging and cervical biopsy.
The guidelines include recommendations such as offering local anesthetics like lidocaine injection, spray or cream for the insertion of an IUD, a small device placed in the uterus to prevent pregnancy. The insertion of an IUD -- which goes through the opening of the cervix to reach the uterus -- can include cramping and is thought by many patients to be painful.
Other pain management options for procedures may include NSAIDs and other medications, such as misoprostol, according to ACOG.
The guidelines also call on physicians to use pain relief options even when evidence is limited, and to involve patients in choosing what works best for them.
"As a women's health nurse practitioner, I treat patients every day who express anxiety about pain related to common procedures like IUD placement," Genevieve Hofmann, co-author of the guidance, said in a statement shared by ACOG. "Unfortunately, many patients feel their pain has been diminished or dismissed by their clinicians, which data shows can lead to patient dissatisfaction and distrust."
She continued, "ACOG's new guidance provides critically important patient-centered recommendations on how to help our patients have better experiences and will help improve trust between patients and clinicians. Though some clinicians have been able to offer some of these pain management options already, I am excited that this guidance will ensure more OB-GYNs and clinicians are discussing pain management options with their patients, and, most importantly, that fewer people will have to endure pain to obtain procedures that are necessary for their health and well-being."
The new guidelines from ACOG are guidance for physicians, not a mandate for care. But they do represent a change in guidance for ACOG, which in the past has stopped short of pain management recommendations due to mixed evidence.
The key in the new guidance, according to ACOG, is that physicians need to counsel patients on their pain management options, engage them in making the best decision and consider each patient individually, noting that a patient's age and examination experience, as well as their own "baseline anxiety" level, may impact how they experience pain.
"Comprehensive counseling is key because patients must be able to decide for themselves what interventions, if any, they would like to try," Dr. Kimberly Hoover, a board-certified OB-GYN and a co-author of the ACOG guidance, said in a statement. "Patients know their own bodies best and know what their priorities are for a procedure -- whether they want it to be completed as quickly as possible, whether their priority is reduction in acute pain, or whether they'd prefer to be able to pause the procedure if needed to try a different intervention."
