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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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1877-8879
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Volume 2, Issue 1

Issues

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:
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/ 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

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Implications

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.

References

  • [1]

    Grimes DA, Susan Smith MS, Witham AD. Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG 2004;111:148–53.CrossrefPubMedGoogle Scholar

  • [2]

    Rørbye C, Nørgaard M, Nilas L. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study. Hum Reprod 2005;20:834–8.CrossrefGoogle Scholar

  • [3]

    Cameron IT, Michie AF, Baird DT. Therapeutic abortion in early pregnancy with antiprogestogen RU486 alone or in combination with prostaglandin analogue (gemeprost). Contraception 1986;34:459–68.PubMedCrossrefGoogle Scholar

  • [4]

    Silvestre L, Dubois C, Renault M, Rezvani Y, Baulieu EE, Ulmann A. Voluntary interruption of pregnancy with mifepristone (RU 486) and a prostaglandin analogue. A large-scale French experience. NEJM 1990;322:645–8.CrossrefGoogle Scholar

  • [5]

    Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. NEJM 1998;338: 1241–7.CrossrefGoogle Scholar

  • [6]

    Price DD. Psychological and neural mechanisms of the affective dimension of pain. Science 2000;288:1769–72.CrossrefPubMedGoogle Scholar

  • [7]

    Gracely RH, McGrath P, Dubner R. Validity and sensitivity of ratio scales of sensory and affective verbal pain descriptors: manipulation of affect by diazepam. Pain 1978;5:19–29.PubMedCrossrefGoogle Scholar

  • [8]

    Gracely RH, McGrath P, Dubner R. Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations. Science 1979;203:1261–3.CrossrefPubMedGoogle Scholar

  • [9]

    Kauppila T, Kemppainen P, Tanila H, Pertovaara A. Effect of systemic medetomidine, an alpha2 adrenoceptor agonist, on experimental pain in humans. Anesthesiology 1992;74:3–8.Google Scholar

  • [10]

    Belanger E, Melzack R, Lauzon P. Pain on first-trimester abortion: a study of psychosocial and material predictors. Pain 1989;36:339–50.CrossrefGoogle Scholar

  • [11]

    Wells N. Pain and distress during abortion. Health Care Women Int 1991;12:293–302.PubMedCrossrefGoogle Scholar

  • [12]

    Wiebe E. Pain control in medical abortion. Int J Gynaecol Obstet 2001;74:275–80.CrossrefPubMedGoogle Scholar

  • [13]

    Bond MR, Pilowsky I. Subjective assessment of pain and its relationship to the administration of analgesics in patients with advanced cancer. J Psychosomatic Res 1966;10:203–8.CrossrefGoogle Scholar

  • [14]

    Margolis RB, Tait RC, Krause SJ. A rating system for use with patient pain drawings. Pain 1986;24:57–65.CrossrefPubMedGoogle Scholar

  • [15]

    Niinimaki M, Jouppila P, Martikainen H, Talvensaari-Mattila A. A randomized study comparing efficacy and patient satisfaction in medical or surgical treatment of miscarriage. Fertil Steril 2006;86:367–72.CrossrefPubMedGoogle Scholar

  • [16]

    Fiala C, Swahn ML, Stephansson O, Gemzell-Danielsson K. The effect of non-steroidal anti-inflammatory drugs on medical abortion with mifepristone and misoprostol at 13-22 weeks gestation. Hum Reprod 2005;20:3072–7.CrossrefPubMedGoogle Scholar

  • [17]

    Redelmeier DA, Kahneman D. Patients’ memories of painful medical treatments: real-time and retrospective evaluations of two minimally invasive procedures. Pain 1996;66:3–8.PubMedCrossrefGoogle Scholar

  • [18]

    Krulewitch H, London MR, Skakel VJ, Lundstedt GJ, Thomason H, Brummel-Smith K. Assessment of pain in cognitively impaired older adults: a comparison of pain assessment tools and their use by non-professional caregivers. J Am Geriatr Soc 2000;48:1607–11.CrossrefGoogle Scholar

  • [19]

    Gedney JJ, Logan H. Memory for stress-associated acute pain. J Pain 2004;5(March (2)):83–91.PubMedCrossrefGoogle Scholar

  • [20]

    Gedney JJ, Logan H, Baron RS. Predictors of short-term and long-term memory of sensory and affective dimensions of pain. J Pain 2003;4:47–55.CrossrefPubMedGoogle Scholar

  • [21]

    Hamoda H, Ashok PW, Flett GMM, Templeton A. Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation. BJOG 2004;111:996–1000.PubMedCrossrefGoogle Scholar

  • [22]

    Bjørge L, Johnsen SL, Midbøe G, Augestad G, Økland I, Helland H, Stray-Pedersen S, Iversen OE. Early pregnancy termination with mifepristone and misoprostol in Norway. Acta Obstet Gynecol Scand 2001;80:1056–61.CrossrefPubMedGoogle Scholar

  • [23]

    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. Fertil Steril 2009;91: 1877–80.PubMedCrossrefWeb of ScienceGoogle Scholar

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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