Measurement of pain during first trimester medical abortion: an exploratory qualitative study

INTRODUCTION: Pain is a recognised side effect of medical abortion, however there is limited information on the experience and treatment of this pain. Qualitative data are needed to understand pain during medical abortion and how this pain might relate to measurement scales for clinical practice and research studies. MATERIALS AND METHODS: We conducted a single-centre exploratory qualitative study in Edinburgh UK, interviewing 32 patients who had undergone medical abortion at home at less than 12 weeks pregnant. We interviewed them two to six weeks after their abortion. We analysed data thematically using a framework approach and asked participants to share pain ratings on a series of different pains scales. RESULTS: For most participants, the pain they experienced was more intense or prolonged than they felt the abortion service indicated it would be and would have preferred more detailed information in advance of the procedure. Use of analgesia was variable, as was response to analgesia when it was used correctly. Existing pain-rating scales, including numerical rating scales and descriptive Likert scales, did not clearly reflect the intensity of pain described in participants' accounts. An 11-point numerical rating scale with incorporation of verbal descriptors of intensity and temporality, was endorsed as a potential future approach. CONCLUSIONS: Patients require more detailed descriptions of pain during medical abortion. Existing pain-rating scales inadequately capture divergent abortion-pain experiences and development of a new tool is needed.