The experience of pain in real-time during medication abortion

EmmaKate B Friedlander; Shandhini Raidoo; Reni Soon; Jennifer Salcedo; James Davis; Mary Tschann; Tiana Fontanilla; Wakako Horiuchi; Bliss Kaneshiro

doi:10.1016/j.contraception.2022.03.003

The experience of pain in real-time during medication abortion

Contraception. 2022 Jun:110:71-75. doi: 10.1016/j.contraception.2022.03.003. Epub 2022 Mar 11.

Authors

EmmaKate B Friedlander¹, Shandhini Raidoo², Reni Soon¹, Jennifer Salcedo¹, James Davis³, Mary Tschann¹, Tiana Fontanilla¹, Wakako Horiuchi¹, Bliss Kaneshiro¹

Affiliations

¹ Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.
² Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA. Electronic address: sraidoo@hawaii.edu.
³ Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.

PMID: 35283083
DOI: 10.1016/j.contraception.2022.03.003

Abstract

Objective: We aimed to characterize the current pain experience of patients completing an evidence-based mifepristone-misoprostol medication abortion regimen using real-time pain scores.

Study design: We collected real-time data on pain experienced by 54 women undergoing medication abortion using an evidence-based regimen of 200 mg mifepristone and 800 mcg buccal misoprostol. These women were enrolled in the placebo arm of a study on the effect of pregabalin for pain during medication abortion. All participants were dispensed ibuprofen and oxycodone/acetaminophen for analgesia. We assessed maximum pain experienced by participants on an 11-point numerical rating scale (NRS), duration of pain, and analgesic usage. Data was collected through electronic surveys sent via text message link at 6 specified points over 72 hours.

Results: Of the 54 women randomized to the placebo group, 2 were lost to follow-up. Participants experienced a mean maximum pain score of 5.5 ± 2.2. The mean time to maximum pain was 3.7 ± 2.4 hours after misoprostol. By hour 12 after misoprostol, 60.8% of participants reported no pain, which increased to 76.9% at 24 hours and 82.0% at 72 hours. Participants reported median ibuprofen usage of 2 800 mg tablets and median oxycodone/acetaminophen usage of one-half of a 5/325mg tablet. Approximately 12.0% of participants reported taking zero ibuprofen tablets, and 50.0% reported no opioid usage during the study period.

Conclusions: Our real-time data collection demonstrated lower mean maximum experienced pain scores and shorter duration of pain than previously reported for medication abortion. Analgesic use was lower than previously described.

Implications: This updated characterization of pain experienced during an evidence-based medication abortion regimen may allow for better pain-related counseling, tailoring of opioid prescription practices, and improvement in patient satisfaction.

Keywords: Analgesic use; Medication abortion; Pain; Pain experience.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Induced* / adverse effects
Abortion, Induced* / methods
Acetaminophen / therapeutic use
Analgesics* / therapeutic use
Analgesics, Opioid / therapeutic use
Female
Humans
Ibuprofen / therapeutic use
Mifepristone / therapeutic use
Misoprostol / therapeutic use
Oxycodone / therapeutic use
Pain* / etiology
Pain* / prevention & control
Pregnancy

Substances

Analgesics
Analgesics, Opioid
Misoprostol
Mifepristone
Acetaminophen
Oxycodone
Ibuprofen