Different doses of ibuprofen for management of pain during medical abortion: a quality improvement study

IntroductionMedical abortion is known to be painful, with pain impacting acceptability and satisfaction for patients. Recommendations to use Non-Steroidal Anti-inflammatory Drugs (NSAIDs) to manage pain are based upon studies using higher than routinely prescribed single doses of ibuprofen (800mg-1600mg).MethodsWe conducted a two-phase quality improvement project in Edinburgh, UK. We advised patients undergoing medical abortion at home under 12 weeks gestation in phase 1 to administer a single dose of 400mg ibuprofen orally up to 1 hour prior to misoprostol administration. In phase 2 of the project, we advised patients to use a single dose of oral 800mg ibuprofen. Two weeks later, patients were asked via text message to report pain score (maximum pain recorded on day of misoprostol), timing of ibuprofen and use of other analgesics. ResultsDuring the project period, 529 women received early medical abortion from the service, 270 in Phase 1and 259 in Phase 2. In Phase 1, 109 (40.4%) responded to follow up contact and provided information on pain scores, and 115 (44.4%) responded from phase 2. Similar, high proportions of patients used ibuprofen as directed in both phases. Overall, there were no differences in pain score between groups: Median score was 7/10 and mean score was 6.7/10 on a numerical rating scale in both groups.ConclusionPain ratings during medical abortion remained high and did not appear to improve when increasing the dose of ibuprofen from 400mg to 800mg. Further research is needed for higher doses of ibuprofen and alternative NSAID preparations.