Evidence-based guidelines on the management of pain associated with first-trimester medical abortion are lacking. Most published clinical trials have failed to report on this important aspect of the procedure. The aim of this comprehensive work was to provide clinical advice based on a comprehensive literature review, supplemented by the clinical experience of a group of European experts in case no evidence is available. Pain level ranged from 5 to 8 in 80% of studies where pain was measured on a 0-10 visual analogue scale; severe pain was reported by 20-80% of women. Pain assessment was rarely reported in studies. Pain treatment should be preventive and avoidance of unnecessary uterine contractions should be considered. Analgesic treatment should follow the WHO three-step ladder, starting with the use of NSAIDs and allowing for easily available back-up treatment with weak opioids.

Altius Pharma CS Paris France

Cap Evidence Paris France

Chalmers Centre NHS Lothian Edinburgh Scotland

Clinica Euskalduna Bilbao Spain

Department of Obstetrics and Gynaecology Palacky University Hospital Olomouc Czech Republic

Department of Women's and Children's Health Division of Obstetrics and Gynaecology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden

Gynmed Clinic Vienna Austria

Obstetric and Gynecology Department La Conception Hospital Marseille France

Obstetric Service Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

San Filippo Neri Hospital Rome Italy

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$a Management of pain associated with up-to-9-weeks medical termination of pregnancy (MToP) using mifepristone-misoprostol regimens: expert consensus based on a systematic literature review / $c C. Fiala, A. Agostini, T. Bombas, S. Cameron, R. Lertxundi, M. Lubusky, M. Parachini, L. Saya, B. Trumbic, K. Gemzell Danielsson

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$a Evidence-based guidelines on the management of pain associated with first-trimester medical abortion are lacking. Most published clinical trials have failed to report on this important aspect of the procedure. The aim of this comprehensive work was to provide clinical advice based on a comprehensive literature review, supplemented by the clinical experience of a group of European experts in case no evidence is available. Pain level ranged from 5 to 8 in 80% of studies where pain was measured on a 0-10 visual analogue scale; severe pain was reported by 20-80% of women. Pain assessment was rarely reported in studies. Pain treatment should be preventive and avoidance of unnecessary uterine contractions should be considered. Analgesic treatment should follow the WHO three-step ladder, starting with the use of NSAIDs and allowing for easily available back-up treatment with weak opioids.

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