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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 335-340    DOI: 10.31083/j.ceog.2020.03.2073
Original Research Previous articles | Next articles
A psychological factor associated with pain during intrauterine device insertion: emotional reactivity
Y. Akdemir1, *(), M. Karadeniz2
1Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
2Zonguldak Maternity Hospital, Zonguldak, Turkey
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Abstract  

Objective: Although the experience of pain is multidimentional, and general psychological factors such as anxiety are found to be associated with acute pain, it is necessary to investigate individual emotional variables such as emotional reactivity (ER). The aim of this study was to determine if increased ER is associated with pain during intrauterine device (IUD) insertion even without existing pre-procedure anxiety. Study Design: Prospective cohort study. Methods: We measured the anxiety level in 237 women using the Beck Anxiety Inventory and the ER level using the Emotional Reactivity Scale (ERS) at Zonguldak Maternity Hospital between November 2018 and March 2019. The women rated their pain during IUD insertion. To evaluate the role of ER in the prediction of pain during IUD insertion, we divided the women into subgroups based on the presence of anxiety and level of pain during IUD insertion. Results: ER was higher in women who had anxiety and moderate-severe pain (p = 0.001). In women who were not anxious, ER was higher in those who had moderate-severe anticipated pain or IUD insertion pain than in those who had mild anticipated pain or IUD insertion pain (p = 0.001). In anxious women, the ERS cut-off value was ? 34 for predicting the level of pain whereas in non-anxious women, it was ? 25. Conclusion: ER is a psychological factor strongly associated with pain at IUD insertion and the ERS appears to be a beneficial tool for detecting ER for this purpose. Health professionals should be aware that psychological factors could contribute to perceived pain more than physiological factors do. Implications: ER is a psychological factor associated with pain at IUD insertion and increased ER is a predictive factor for pain during IUD insertion even without existing pre-procedure anxiety. ERS seems to be a beneficial tool for detecting ER.

Key words:  Intrauterine Device      Anxiety      Pain      Emotional Reactivity     
Submitted:  15 September 2019      Accepted:  11 March 2020      Published:  15 June 2020     
*Corresponding Author(s):  YESİM AKDEMİR     E-mail:  yesimakdemir@yahoo.com

Cite this article: 

Y. Akdemir, M. Karadeniz. A psychological factor associated with pain during intrauterine device insertion: emotional reactivity. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 335-340.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.2073     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/335

Figure 1.  — Study design flow chart.

Table 1  — Demographic characteristics, obstetric history and clinical characteristics of women
Characteristics Patients with mild pain
n (120)
Patients with moderate-severe pain
n (117)
p valuee
Age* 33.60 ± 8.40 32.77 ± 6.80 0.055
BMI* 29.39 ± 3.84 25.57 ± 4.06 0.138
Occupation
n [%]
24 [20] 18 [15.4] 0.447
Lactating
n [%]
36 [30] 42 [35.9] 0.334
Previous IUDa insertion experience 84 [70] 42 [35.9] 0.001
Nulliparity 27 [22.5] 39 [33.3] 0.63
Multiparity 93 [77.5] 78 [66.7] 0.63
Anticipated VASb pain scores* 23.00 ± 16.68 58.71 ± 22.18 0.001
VAS pain scores at IUDa insertion* 15.25 ± 7.09 53.00 ± 19.84 0.001
ERSc scores* 17.40 ± 9.44 39.84 ± 9.75 0.001
BAId scores* 4.87 ± 8.02 4.43 ± 6.60 0.984
Table 2  — Demographic characteristics, Mean VASa and ERSb scores
Characteristics group 1

anxiety(+) mild pain n(39)
group 2

anxiety(+) moderate-severe pain n(39)
group 3

anxiety(-) mild Pain n(81)
group 4

anxiety(-) moderate-severe pain n(78)
p value
Age* 33.08 ± 5.622 32.31 ± 6.005 31.99 ± 7.012 33.00 ± 7.190 0.098
BMI* 27.46 ± 3.78 25.51 ± 3.56 25.87 ± 3.78 25.61 ± 4.31 0.125
Occupation
n [%]
9 [23.1] 3 [7.7] 15 [18.5] 15 [19.2] 0.306
Lactating
n [%]
9 [23.1] 15 [38.5] 27 [33.3] 27 [34.6] 0.501
Previous IUDc insertion experience 18 [46.2] 15 [38.5] 66 [81.5] 27 [34.6] 0.001
Nulliparity 9 [23.1] 15 [38.5] 18 [22.2] 24 [30.8] 0.237
Multiparity 30 [76.9] 24 [61.5] 63 [77.8] 54 [69.2] 0.237
Anticipated VASa pain scores* 26.92 ± 18.80 66.92 ± 21.17 21.11 ± 15.32 54.61 ± 21.66 0.001e.g.h.i.j
VAS pain scores at IUDb insertion* 16.92 ± 8.32 62.30 ± 24.86 14.44 ± 6.32 48.07 ± 15.29 0.001e.g.h.i.j
ERSc scores* 27.23 ± 7.88 44.00 ± 5.04 12.66 ± 5.78 37.76 ± 10.84 0.001e.f.g.h.i.j
BAId scores* 15.00 ± 6.77 13.30 ± 3.47 - - 0.496e
Figure 2.  — ROC Curves of ERS for discrimination of mild or moderate-severe pain. A) Anxious nullipar women, B) Anxious multipar women, C) Non-anxious nullipar women, D) Non anxious multipar women.

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