Pre-emptive effect of ibuprofen versus placebo on pain relief and success rates of medical abortion: a double-blind, randomized, controlled study

Twenty years of postabortion care (PAC) studies yield strong evidence that:Misoprostol and vacuum aspiration are comparable in safety and effectiveness for treating incomplete abortion.Misoprostol, which can be provided by trained nurses and midwives, shows substantial promise for extending PAC services to secondary hospitals and primary health posts.Postabortion family planning uptake generally increases rapidly-and unintended pregnancies and repeat abortions can decline as a result-when a range of free contraceptives, including long-acting methods, are offered at the point of treatment; male involvement in counseling-always with the woman’s concurrence-can increase family planning uptake and support.

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“…Pain management with ibuprofen, 800 mg to 1000 mg, was generally adequate and clearly superior to paracetamol (acetaminophen). 35 - 37 …”

Section: Resultsmentioning

confidence: 99%

Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

Huber

Curtis²,

Irani

et al. 2016

Glob Health Sci Pract

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“…Avraham et al indicated that pre-emptive effect of ibuprofen for medical abortion pain relief during a mifepristone and misoprostol regimen was statistically significant [19]. NSAIDs not only for medical abortion but also for spontaneous abortions have been studied.…”

Section: Discussionmentioning

confidence: 99%

Pain Control of Medical Abortion with Misoprostol in the First Trimester of Pregnancy

Mahboobeh¹,

Atoof²,

Mamak³

et al. 2017

Gynecol Obstet

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Background: Abortion is the most common subjects of obstetric which has applied two methods including surgical and medical approaches. Pain is the most common complication of medical abortion and pain relief is one the most important items in these patients.Objectives: Evaluated the effect of three non-steroidal anti-inflammatory drugs in pain reduction of medical abortion in less than 14 weeks gestation with forensics declaration. Methods:This study was a retrospective cohort in 66 pregnant women with less than 14 weeks gestation referred to Yas hospital for medical abortion that were assigned to three groups based on sedative drugs: A) Mefenamic acid capsules 250 mg, B) Diclofenac tablets 100 mg and C) Ibuprofen tablets 400 mg. The standardized visual assessment scale was assessed before and after drug administration that presented in medical records of patients. Results:Comparison of visual assessment scale means before and after using of three non-steroidal antiinflammatory drugs demonstrated that all three drugs lead to pain relief after the abortion that was significant statistically (P value=0.001). There was a significant difference in termination time of pregnancy between three groups, (P value= 0.016). In the case of hemoglobin drop, diclofenac lead to the lowest hemoglobin drop (P value=0.004). The amount of receiving narcotic among three groups revealed the significant difference (P value= 0.000). There were not significant differences in pain relief (P value=0.327) and demographic data between three groups. Conclusion:It was indicated that the three NSAIDs drugs, had a significant effect on the management of pain, diclofenac expended less termination time of pregnancy, narcotic drug usage and also hemoglobin drop than other groups.What does this study add? Non-steroidal anti-inflammatory drugs are effective in pain management of medical abortion and some of them are preferred to others. Diclofenac can reduce abortion time and also hemoglobin drop after abortion and additional dose of other narcotics too.

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“…Individual experiences of pain, responses to pain and responses to pain medication are complex and may differ according to ethnicity, socio-economic status, cultural factors, physiology and genetics [ 39 ]. To date, studies investigating ibuprofen to treat pain associated with EMA report on predominantly populations of women in the United States, Canada and Israel [ 9 , 10 , 13 , 34 ]. In contrast to prior studies, our proposal emphasizes investigation of new pain management approaches in populations of women from Africa and Asia.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, the use of misoprostol, which is a prostaglandin analogue, with NSAIDs could result in a drug interaction which decreases the effectiveness of the medical abortion. Despite this theoretical concern, clinical studies have not demonstrated a difference [ 13 , 34 , 35 ]. Further, no known drug interactions between tramadol and mifepristone or misoprostol, metoclopramide and mifepristone or misoprostol or between ibuprofen and metoclopramide have been reported [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

Two prophylactic medication approaches in addition to a pain control regimen for early medical abortion < 63 days’ gestation with mifepristone and misoprostol: study protocol for a randomized, controlled trial

Grossman¹,

Kapp

Huong

et al. 2016

Reprod Health

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BackgroundPain is often cited as one of the worst features of medical abortion. Further, inadequate pain management may motivate some women to seek unnecessary clinical care. There is a need to identify effective methods for pain control in this setting.Methods/DesignWe propose a randomized, placebo-controlled trial. 576 participants (288 nulliparous; 288 parous) from study sites in Nepal, South Africa and Vietnam will be randomly allocated to one of three treatments: (1) ibuprofen 400 mg PO and metoclopramide 10 mg PO; (2) tramadol 50 mg PO and a placebo; or (3) two placebo pills, to be taken immediately before misoprostol and repeated once four hours later. All women will be provided with supplementary analgesia for use as needed during the medical abortion. We hypothesize that women receiving prophylactic analgesia will report lower maximal pain scores in the first 8 h following misoprostol administration compared to women receiving placebos for medical abortion through 63 days’ gestation. Our primary objective is to determine whether prophylactic administration of ibuprofen and metoclopramide or tramadol provides superior pain relief compared to analgesia administration after pain begins, measured during the first eight hours after misoprostol administration. Secondary objectives include identifying covariates associated with higher reported pain scores; determining any impact of the study medicines on medical abortion success; and, qualitatively exploring women’s physical experiences of medical abortion, especially related to pain, and how can they be improved. Data sources include medical records, participant symptom diaries and interview data obtained on the day of enrollment, during the medical abortion, and at follow-up. Participants will be contacted via telephone on day 3 and return for follow-up will occur approximately 14 days after mifepristone, concluding study participation. A subset of 42 women will also be invited to undergo in-depth qualitative interviews following study completion.DiscussionAlthough pain is one of the most common side effects encountered with medical abortion, little is known about optimal pain management for this process. This multi-arm trial design offers an efficient approach to evaluating two prophylactic pain management regimens compared to use of pain medication as needed.Trial registration ACTRN12613000017729 (Prospectively registered 8/1/2013).

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Pre-emptive effect of ibuprofen versus placebo on pain relief and success rates of medical abortion: a double-blind, randomized, controlled study

Cited by 30 publications

References 15 publications

Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

Pain Control of Medical Abortion with Misoprostol in the First Trimester of Pregnancy

Two prophylactic medication approaches in addition to a pain control regimen for early medical abortion < 63 days’ gestation with mifepristone and misoprostol: study protocol for a randomized, controlled trial

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