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Background <p>To determine and compare the pain relief between Acetaminophen, Mefenamic Acid and Diclofenac Sodium in participants who had just had Implanon NXT<sup>®</sup> inserted.</p> Methods <p>129 healthy female participants were recruited from four clinics prior to Implanon NXT<sup>®</sup> insertion. They were randomized to receive either tablet Acetaminophen; tablet Mefenamic Acid; tablet Diclofenac Sodium; or no drugs. Post insertion, participants marked their pain score on a 100&#xa0;mm Visual Analogue Scale (VAS) line during Lignocaine injection, Implanon NXT<sup>®</sup> insertion, 2&#xa0;hours post insertion, 4&#xa0;hours post insertion, and every day thereafter for 7 days; once in the morning before taking any analgesic, and once again after taking the prescribed analgesic. The Pain Intensity Difference (PID) and Sum of Pain Intensity Differences (SPID) were calculated for each drug.</p> Results <p>The Sum of Pain Intensity Differences (SPID) for Diclofenac Sodium group is 1009&#xa0;mm VAS, for Mefenamic Acid group is 446&#xa0;mm VAS, for Acetaminophen group is 296&#xa0;mm VAS, and for Control group is 58&#xa0;mm VAS. Kruskal Wallis ANOVA indicated that there were statistically significant differences between the Pain Intensity Differences on Day 2 (PID2) assigned to the “Mefenamic Acid” group and “Control” group (<i>p</i> = 0.021, adjusted significance (Bonferroni’s) <i>p</i> = 0.013). The ANCOVA indicated that, after accounting for the effects of different baseline pain intensities at the beginning of the study, there was a statistically significant effect of drugs used on Pain Intensity Difference Day 2 (PID2), <i>p</i> = 0.024, partial ƞ2 = 0.07. Post-hoc testing revealed that the participants in the Mefenamic Acid group reported higher Pain Intensity Difference on Day 2 (PID2) than the Control group.</p> Conclusion <p>All oral analgesics demonstrated a reduction in pain score. Based on this limited study, the most suitable analgesic for pain management post Implanon NXT<sup>®</sup> insertion is tablet Mefenamic Acid 250&#xa0;mg twice daily for up to 2 days. More robust double-blinded studies using placebos as a control are needed to confirm this finding. </p> Trial registration <p>This study was retrospectively registered with the Thai Clinical Trial Registry: TCTR20260331002 (<a href="https://www.thaiclinicaltrials.org/show/TCTR20260331002">https://www.thaiclinicaltrials.org/show/TCTR20260331002) on 31st March 2026.</a></p>

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How painful is Implanon NXT® insertion?: A multicenter randomized trial on the use of Acetaminophen, Mefenamic Acid and Diclofenac Sodium for pain management post Implanon NXT® insertion

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Nik Asyraf Nik Azis,
  • Mohamed S. Zulfarina ,
  • Nurul ‘Izzah Ibrahim ,
  • Alina Ali,
  • Alia Syamim ZaharI,
  • Norhalili Mohamad Tamiri,
  • Aisyah Sulaiman,
  • Ng Xue Min,
  • Azura Abdullah,
  • Isa Naina-Mohamed

摘要

Background

To determine and compare the pain relief between Acetaminophen, Mefenamic Acid and Diclofenac Sodium in participants who had just had Implanon NXT® inserted.

Methods

129 healthy female participants were recruited from four clinics prior to Implanon NXT® insertion. They were randomized to receive either tablet Acetaminophen; tablet Mefenamic Acid; tablet Diclofenac Sodium; or no drugs. Post insertion, participants marked their pain score on a 100 mm Visual Analogue Scale (VAS) line during Lignocaine injection, Implanon NXT® insertion, 2 hours post insertion, 4 hours post insertion, and every day thereafter for 7 days; once in the morning before taking any analgesic, and once again after taking the prescribed analgesic. The Pain Intensity Difference (PID) and Sum of Pain Intensity Differences (SPID) were calculated for each drug.

Results

The Sum of Pain Intensity Differences (SPID) for Diclofenac Sodium group is 1009 mm VAS, for Mefenamic Acid group is 446 mm VAS, for Acetaminophen group is 296 mm VAS, and for Control group is 58 mm VAS. Kruskal Wallis ANOVA indicated that there were statistically significant differences between the Pain Intensity Differences on Day 2 (PID2) assigned to the “Mefenamic Acid” group and “Control” group (p = 0.021, adjusted significance (Bonferroni’s) p = 0.013). The ANCOVA indicated that, after accounting for the effects of different baseline pain intensities at the beginning of the study, there was a statistically significant effect of drugs used on Pain Intensity Difference Day 2 (PID2), p = 0.024, partial ƞ2 = 0.07. Post-hoc testing revealed that the participants in the Mefenamic Acid group reported higher Pain Intensity Difference on Day 2 (PID2) than the Control group.

Conclusion

All oral analgesics demonstrated a reduction in pain score. Based on this limited study, the most suitable analgesic for pain management post Implanon NXT® insertion is tablet Mefenamic Acid 250 mg twice daily for up to 2 days. More robust double-blinded studies using placebos as a control are needed to confirm this finding.

Trial registration

This study was retrospectively registered with the Thai Clinical Trial Registry: TCTR20260331002 (https://www.thaiclinicaltrials.org/show/TCTR20260331002) on 31st March 2026.