Grand Rounds

Pregabalin: A Prophylactic Treatment to Reduce Medication Abortion Pain?

BACKGROUND AND PURPOSE:

Women undergoing early medication abortions will experience moderate to pain (6-8 on an 11-point scale)
Pregabalin is used prior to surgery to decrease acute pain
Friedlander et al. (Obstetrics and Gynecology, 2018) sought to determine whether prophylactic pregabalin decreased pain experienced with medication abortion

Randomized, double-blind, placebo-controlled trial (RCT)
- Women initiating medication abortion with mifepristone and buccal misoprostol up to 70 days of gestation
Participants were randomized to receive either
- 300 mg oral pregabalin before misoprostol
- placebo before misoprostol
Primary outcome
- Maximum pain on an 11-point numerical rating scale
- Reported using real-time electronic surveys over 72 hours
Secondary outcomes
- Pain at each time point | Ibuprofen and narcotic use | Side effects | Satisfaction

110 women were randomized
- 56 pregabalin | 54 placebo
The mean maximum pain was similar between groups
- 0±2.6 in the pregabalin group
- 5±2.2 in the placebo group
Ibuprofen was used by significantly more women in the placebo group (P<.01)
- 64% of the pregabalin group
- 87% placebo
Narcotics were used by more women in the placebo group (P<.03)
- 29% of the pregabalin group
- 50% placebo
The following side effects that were more common in the pregabalin group
- Dizziness (P<.001)
- Sleepiness (P<.04)
- Blurred vision (P<.05)
Satisfaction scores (‘very satisfied’) were higher in the pregabalin group (P=.006)
- Pregabalin: 47%
- Control: 22%

Pregabalin did not impact peak pain scores
Women in the pregabalin group
- were less likely to require ibuprofen or narcotics
- reported higher satisfaction, despite side effects
The authors state that based on these results, in particular decreased need for narcotics and ease of use, pregabalin is “a worthwhile adjunct in medication abortion care”

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