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

METHODS:

  • 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

RESULTS:

  • 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%

CONCLUSION:

  • 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”

Learn More – Primary Sources:

Prophylactic Pregabalin to Decrease Pain During Medication Abortion: A Randomized Controlled Trial