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Dextromethorphan as a novel nonopioid adjunctive agent for pain control with medication abortion: A randomized controlled trial

      Abstract

      Objectives

      To evaluate efficacy and satisfaction of dextromethorphan as a non-narcotic adjuvant to current analgesic regimens for medication abortion.

      Study Design

      We conducted a randomized, double-blinded, placebo-controlled trial. We randomized eligible participants (N = 156) 1:1 to adjunctively take dextromethorphan (loading dose 60 mg and two subsequent 30 mg doses at 2 and 5 hours after misoprostol administration) or placebo combined with usual-care nonsteroidal anti-inflammatory medications ± opioids for pain. Participants reported pain scores and satisfaction using a secure texting application at 2, 5, 8, and 24 hours after misoprostol administration. Our primary outcome was worst pain score and total analgesic use.

      Results

      Baseline demographics of enrolled participants were similar between randomization arms. Worst pain scores for participants receiving dextromethorphan versus placebo (8.0 vs 7.0, p = 0.06) did not differ. Total milligram usage of ibuprofen (800 mg vs 610 mg, p =.62), acetaminophen (1000 mg vs 1300 mg, p = 0.62), and opioids (10 mg vs 15 mg, p = 0.51) did not differ between the randomization groups. Participants randomized to placebo were significantly more likely to be satisfied with their pain control (91% vs 75%, p = 0.02).

      Conclusion

      Dextromethorphan used adjunctively with standard analgesics did not reduce pain associated with medication abortion. Participants who received dextromethorphan reported decreased satisfaction with their pain control.

      Implications

      Dextromethorphan used adjunctively with commonly used analgesic regimens did not reduce medication abortion associated pain. Many participants did not use analgesics as counseled, and nearly 25% used no analgesia during medication abortion.

      Keywords

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      References

        • Jones R
        • Jerman J.
        Abortion incidence and service availability in the United States.
        Perspect on Sex Reprod Health. 2014; 1 (2017): 17-27https://doi.org/10.1363/psrh.12015
        • Suhonen S
        • Tikka M
        • Kivinen S
        • Kauppila T.
        Pain during medical abortion: predicting factors from gynecologic history and medical staff evaluation of severity.
        Contraception. 2011; 83: 357-361https://doi.org/10.1016/j.contraception.2010.08.006
        • Livshits A
        • Machtinger R
        • David LB
        • Spira M
        • Moshe-Zahav A
        • Seidman DS.
        Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study.
        Fertility and Sterility. 2009; 91: 1877-1880https://doi.org/10.1016/j.fertnstert.2008.01.084
        • Wiebe E.
        Pain control in medical abortion.
        Int J Gynecol & Obstetrics. 2001; 74: 275-280https://doi.org/10.1016/S0020-7292(01)00453-2
        • Ehrenreich K
        • Biggs MA
        • Grossman D.
        Medication abortion up to 70 days of gestation.
        Contraception. 2020; 102: 225-236https://doi.org/10.1016/j.contraception.2020.08.004
        • Penney G.
        Treatment of pain during medical abortion.
        Contraception. 2006; 74: 45-47https://doi.org/10.1016/j.contraception.2006.03.002
        • Wiegerinck MMJ
        • Jones HE
        • O'Connell K
        • Lichtenberg ES
        • Paul M
        • Westhoff CL
        Medical abortion practices: a survey of National Abortion Federation members in the United States.
        Contraception. 2008; 78: 486-491https://doi.org/10.1016/j.contraception.2008.07.015
      1. [email protected]: FDA-Approved Drugs n.d. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=091135 (accessed July 7, 2021).

        • Boyer EW
        Dextromethorphan abuse.
        Pediatric Emerg Care. 2004; 20: 858-863https://doi.org/10.1097/01.pec.0000148039.14588.d0
        • Weinbroum AA
        • Rudick V
        • Paret G
        • Ben-Abraham R.
        The role of dextromethorphan in pain control.
        Can J Anesth. 2000; 47: 585-596https://doi.org/10.1007/BF03018952
        • Henderson DJ
        • Withington BS
        • Wilson JA
        • Morrison LMM.
        Perioperative dextromethorphan reduces postoperative pain after hysterectomy.
        Anesth & Analgesia. 1999; 89: 399-402https://doi.org/10.1213/00000539-199908000-00028
        • Chia Y-Y
        • Liu K
        • Chow L-H
        • Lee T-Y.
        The preoperative administration of intravenous dextromethorphan reduces postoperative morphine consumption.
        Anesth & Analgesia. 1999; 89: 748-752https://doi.org/10.1213/00000539-199909000-00041
        • Rose JB
        • Cuy R
        • Cohen DE
        • Schreiner MS.
        Preoperative oral dextromethorphan does not reduce pain or analgesic consumption in children after adenotonsillectomy.
        Anesth & Analgesia. 1999; 88: 749-753https://doi.org/10.1213/00000539-199904000-00012
        • McConaghy PM
        • McSorley P
        • McCaughey W
        • Campbell WI.
        Dextromethorphan and pain after total abdominal hysterectomy.
        Br J Anaesth. 1998; 81: 731-736https://doi.org/10.1093/bja/81.5.731
        • Bem JL
        • Dextromethorphan Peck R.
        Drug-Safety. 1992; 7: 190-199https://doi.org/10.2165/00002018-199207030-00004
        • Duedahl TH
        • Rømsing J
        • Møiniche S
        • Dahl JB.
        A qualitative systematic review of peri-operative dextromethorphan in post-operative pain.
        Acta Anaesthesiologica Scandinavica. 2006; 50: 1-13https://doi.org/10.1111/j.1399-6576.2006.00900.x
        • Colwill AC
        • Bayer LL
        • Bednarek P
        • Garg B
        • Jensen JT
        • Edelman AB.
        Opioid analgesia for medical abortion: a randomized controlled trial.
        Obstetrics & Gynecol. 2019; 134: 1163-1170https://doi.org/10.1097/AOG.0000000000003576
        • Bicket MC
        • Long JJ
        • Pronovost PJ
        • Alexander GC
        • Wu CL.
        Prescription opioid analgesics commonly unused after surgery: a systematic review.
        JAMA Surg. 2017; 152: 1066-1071https://doi.org/10.1001/jamasurg.2017.0831
        • Friedlander EB
        • Raidoo S
        • Soon R
        • Salcedo J
        • Davis J
        • Tschann M
        • et al.
        The experience of pain in real-time during medication abortion.
        Contraception. 2022; 110: 71-75https://doi.org/10.1016/j.contraception.2022.03.003