We thank Dr. Creinin for his comments on and interest in our article.1 We agree that our findings reveal small absolute differences in pain scores, and we do not know with certainty whether these differences are clinically relevant. However, several studies suggest that a 30% difference in visual analogue pain scores is clinically significant.2,3 Although the absolute pain scores after intrauterine device insertion (IUD) were low in our study, we observed a reduction in pain scores by 37% at 5 minutes and 47% at 15 minutes postinsertion in the naproxen sodium group (26.0 mm compared with 16.5 mm at 5 minutes and 24.0 mm compared with 12.8 mm at 15 minutes, placebo compared with naproxen sodium, respectively).
In deciding whether to recommend naproxen sodium, we must weigh the risks and benefits of this before a patient takes the medication. Based on our study findings, naproxen sodium appears to provide a small reduction in post-IUD insertion pain. Similarly, the risk and cost of a one-time dose of 550 mg naproxen sodium is small. With adequate counseling, the patient can choose whether it is worthwhile for her to take naproxen sodium before IUD insertion. We believe that, for many women, even a small benefit will outweigh the risks.