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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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Volume 2, Issue 1


The level of unpleasantness of pain influences the choice of home treatment during medical abortion

Satu Suhonen
  • Department of Gynaecology and Obstetrics of the Helsinki University Hospital, Helsinki, Finland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marja Tikka
  • Department of Gynaecology and Obstetrics of the Helsinki University Hospital, Helsinki, Finland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Seppo Kivinen
  • Department of Gynaecology and Obstetrics of the Helsinki University Hospital, Helsinki, Finland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Timo Kauppila
  • Corresponding author
  • City of Vantaa, Network of Academic Health Centres, Department of Public Health and Department of General Practice and Primary Health Care, HUS, University of Helsinki, Helsinki, Finland
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2011-01-01 | DOI: https://doi.org/10.1016/j.sjpain.2010.09.007


Background and aims

Medical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.


We studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.


Especially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.


The unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.


These patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

Keywords: Medical abortion; Pain; Mifepristone; Unpleasantness; Intensity

DOI of refers to article: 10.1016/j.sjpain.2010.11.004.


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About the article

Korso Health Center, Naalipolku 6, 01450 Vantaa, Finland. Tel.: +358 9 83911; fax: +358 9 83932624

Received: 2009-10-31

Revised: 2010-09-26

Accepted: 2010-09-27

Published Online: 2011-01-01

Published in Print: 2011-01-01

Citation Information: Scandinavian Journal of Pain, Volume 2, Issue 1, Pages 19–23, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2010.09.007.

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