Pain during medical abortion, the impact of the regimen: A neglected issue? A review

Objectives To evaluate pain and other early adverse events associated with different regimens of medical abortion up to nine weeks of amenorrhoea.Methods The literature was searched for comparative studies of medical abortion using mifepristone followed by the prostaglandin analogue misoprostol. Publications, which included pain assessment were further analysed.Results Of the 1459 publications on medical abortion identified, only 23 comparative, prospective trials corresponded to the inclusion criteria. Patients in these studies received different dosages of mifepristone in combination with different dosages of misoprostol administered via diverse routes or at various intervals. Information on pain level was reported in 12/23 papers (52%), information regarding systematic administration of analgesics in 12/23 articles (52%) and information concerning analgesia used was available for only 10/23 studies (43%).Conclusions Neither pain nor its treatment are systematically reported in clinical trials of medical abortion; this shortcoming reflects a neglect of the individual pain perception. When data are mentioned, they are too inconsistent to allow for any comparison between different treatment protocols. Standardised evaluation of pain is needed and the correlation between the dosage of misoprostol and the intensity of pain must be assessed in future studies.Chinese Abstract摘要 目的 为了评价停经9周药物流产不同方案相关的疼痛及其它早期不良反应。方法 检索米非司酮联合前列腺素类似物米索前列醇进行药物流产的对照研究的相关文献。已发表的文献中疼痛评估被进一步分析。结果在1459项药物性流产研究中，仅有23项对照性、前瞻性的研究符合纳入标准。在这些研究中病人接受了不同剂量的米非司酮及米索前列醇，给药途径及给药时间间隔也不同。其中12/23篇文献（52%）报道了有关疼痛程度的信息，12/23篇文献（52%）报道了镇痛药系统性管理的有关信息，10/23（43%）篇文献（52%）报道了镇痛剂使用的有关信息。结论：药物流产临床试验过程中无论是疼痛还是其治疗都没有被系统报道。这反映了对个人痛苦感受的忽视。被提及的数据完全不匹配，因此不同治疗方案之间无法进行比较。标准化疼痛评估以及米非司酮剂量和疼痛程度的相关性需要在将来的研究中进行。