To determine factors predicting severe pain among patients having mifepristone-misoprostol
medication abortion at ≤9 weeks’ gestation.
A randomized, placebo-controlled trial in Vietnam, Nepal, and South Africa assessed
pain levels with use of prophylactic tramadol, ibuprofen/metoclopramide, or placebo.
This is a secondary analysis to identify predictors of severe pain. Primary outcome
was maximum pain score (scale 0–10) within eight hours of taking misoprostol, analyzed
as a dichotomized variable.
556 patients enrolled between June 2016 and October 2017 were included; 283 (50.9%)
had maximum pain score of 8 (49.1%). In multivariable analysis, controlling for study
center and prophylactic treatment arm, history of prior vaginal delivery (OR, 0.37;
95% CI, 0.24–0.55) was associated with reduced odds of severe pain while higher gestational
duration (OR, 1.05; 95% CI, 1.01–1.09), higher pain score for menstrual cramps (OR,
1.16; 95% CI, 1.07–1.26), and higher anticipated pain score (OR, 1.11; 95% CI, 1.00–1.24)
were associated with increased odds of severe pain. Sociodemographic variables including
marital status, education, employment, food insecurity, housing instability, and history
of anxiety or depression were not associated with severe pain.
In addition to known risk factors such as parity and gestational duration, this analysis
identified new predictors of having severe pain with medication abortion. Patients
seeking medication abortion should be counseled about the factors that may increase
their risk of having severe pain as well as given options for prophylactic pain management
to help them better prepare for and manage their abortion experience.