TENS fails to ease pain during IUD insertion

Clinical takeaway: Do not rely on high-frequency TENS to reduce IUD insertion pain. Discuss pain-management options before placement and ask patients directly about their discomfort rather than relying on clinician estimates.

Pain during intrauterine device (IUD) insertion remains a significant patient concern, prompting interest in nonpharmacologic approaches. Transcutaneous electrical nerve stimulation (TENS), which delivers mild electrical impulses through skin electrodes, offers a drug-free option but a new randomized trial found no significant pain benefit during placement.

The double-blind study included 98 participants undergoing insertion of a 52 mg levonorgestrel or copper IUD. Participants received active high-frequency TENS or sham stimulation.

Average pain at insertion was virtually identical: 50.8 mm with active TENS versus 50.6 mm with sham on a 100 mm pain scale, a difference that was not statistically significant.

Participants who had never given birth reported higher insertion pain than those with a prior delivery, but active stimulation did not significantly reduce pain in either group. Procedures clinicians considered difficult were associated with significantly higher patient-reported pain.

A separate finding highlights a gap in pain assessment. Clinicians estimated patients’ maximum pain at an average of 48.9 mm, compared with patients’ own ratings of 60.5 mm. The approximately 12 mm difference was statistically significant.

The trial does not support high-frequency TENS for reducing IUD insertion pain. The gap between clinician estimates and patient-reported pain also underscores the importance of asking patients directly about their discomfort and using their responses to guide care.

Source: Kus LH, et al. (2026 Oct 8) Am J Obstet Gynecol. Transcutaneous electrical nerve stimulation for pain management during intrauterine device insertion: a randomized controlled trial