An Open Working Group

The green whistle belongs in the IUD conversation.

Millions of women undergo office gynecologic procedures with little or no analgesia. Emergency medicine has spent two decades building the case for rapid, self-administered, needle-free pain relief. This page connects the two: one email thread of EM analgesia experts, women's health leaders, and people who know how to move institutions.

Convened by Rick Pescatore, DO
Emergency Physician · Editor-in-Chief, Emergency Medicine News

01

The moment is real, and it's now.

Pain during IUD placement is common, significant, and routinely underestimated by the clinicians performing the procedure — and most patients are still offered little beyond ibuprofen. The guidance has finally started to move: the CDC's 2024 contraception practice update told clinicians to counsel patients on pain and discuss options before placement, and ACOG followed in 2025 with a clinical consensus on in-office procedural pain. What's missing is a better option to offer.

02

The tool already exists.

Inhaled methoxyflurane — Penthrox, the "green whistle" — is a self-administered analgesic with onset in minutes. No IV, no injection, no sedation infrastructure. It has been used for decades across Australia, New Zealand, and Europe, and in Canada since 2018, with randomized trial support (InMEDIATE, MEDITA, RAMPED) for rapid, clinically meaningful relief of acute pain. It is not available in the United States.

03

The gap is a coalition problem, not an evidence problem.

Nobody has seriously positioned this drug — or the broader EM procedural-analgesia playbook — for office gynecology in the US. That takes emergency medicine and women's health at the same table, with regulatory and industry experience alongside. Hence this page.

Start here — the evidence case
Evidence Mounting for the Green Whistle
Robert Glatter, Sergey M. Motov & Ken Milne
Emergency Medicine News 46(8):21, August 2024 · Free full text
Read the article →
Who this table needs
EM analgesia researchers
The trialists and clinicians who built the acute-pain evidence base.
OB-GYN & women's health leadership
The people who own the procedures, the guidance, and the patients.
Regulatory & industry experience
Anyone who has moved a product or a policy through the machine.
Advocates with reach
The voices who made this a public conversation in the first place.
How this works
  1. Drop your name and email below. That's the whole ask.
  2. You get one personal email from me — rick@belly-md.com — connecting the group. No newsletter, no marketing, nothing automated.
  3. Together we scope the first move: a joint commentary, a structured evidence review, pilot protocols, a regulatory conversation. The group decides.

Join the thread

Your email goes to one working thread, never a marketing list. Want out later? Say so and you're out.

✓

You're on the thread.

Expect a personal note from rick@belly-md.com once the first group is assembled — days, not weeks. Thank you for putting your name next to this.