Dextromethorphan as a novel non-opioid adjunctive agent for pain control in medication abortion: A randomized controlled trial
Awarded 2018
Complex Family Planning Fellowship Research
Grace Ferguson, MD
University of Pittsburgh

Background: Medication abortion is a common method of pregnancy termination in the United States, however, the best way to manage pain during medication abortion is unknown. Most providers offer a combination of over the counter pain medications (most commonly ibuprofen) and narcotics. However, because narcotic pain medications can lead to addiction, better pain medications are needed. This study tested a new medication for pain management in medication abortion.
Dextromethorphan is a common ingredient in cough syrups and is known to be safe in adults and children. Beyond its current use as a cough medicine, there is evidence that it may also help pain control by making other pain medications more effective. Different studies have shown that when used with other pain medications, both narcotic and non-narcotic, participants reported improved pain scores or decreased pain medication usage.
Statement of Purpose: This study tests a non-addictive potential pain medication for use in medication abortion to see if taking dextromethorphan in addition to routine pain medications would reduce pain during medication abortion.
Methodology: In this study, we compared pain scores reported by women who received routine pain medications and a placebo (sugar pill) for their medication abortion with pain scores reported by women who received routine pain medications and dextromethorphan. This study design is a double-blinded, randomized controlled trial. We enrolled 156 participants in order to look for a statistically significant difference in pain between the two groups.
Important Findings: We found that dextromethorphan did not improve pain for women undergoing medication abortion. We also found that only about half of women in our study filled their prescription for narcotic pain medication. Similarly, only about half of women took any ibuprofen during their abortion, which is lower than expected. Despite lower than expected medication usage, self-reported satisfaction with pain control was high overall.
Conclusion: Dextromethorphan does not improve pain in medication abortion.
With or without narcotic pain medications, or even ibuprofen, women generally report being satisfied with their pain control during medication abortion. Providers may consider reducing their frequency of offering routine narcotic pain medications.