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Dextromethorphan ineffective adjuvant option for medication abortion pain management

Results from a randomized controlled trial study suggest dextromethorphan may even worsen patient pain experience.

Dextromethorphan was not a successful adjunctive pain management option for medication abortion, according to research results published in Contraception.1

Through a randomized, double-blinded, placebo-controlled trial, investigators used data from 156 women who were eligible for medication abortion at Planned Parenthood of Western Pennsylvania to evaluate dextromethorphan (DXM) as a non-narcotic option for post-abortion pain management.

Investigators randomized 156 women to adjunctively take DXM—loading dose 60 mg and 2 subsequent 30 mg doses at 2 and 5 hours after misoprostol administration—or placebo combined with nonsteroidal anti-inflammatory medications (NSAIDS) and/or opioids for pain. Patients reported pain scores and satisfaction 2, 5, 8, and 24 hours after misoprostol administration via a secure texting application. The study’s primary outcomes were worst pain score and total analgesic use.

Patients were able to opt for a printed oxycodone prescription—10 tabs of 5 mg—to fill at their pharmacy. All patients received routine counseling to take ibuprofen—600 mg orally every 6 hours as needed and/or acetaminophen for pain control during the medication abortion process and to secondarily use the prescribed opioid as needed.

Results showed no difference in worst pain scores for patients receiving DXM versus placebo (8.0 vs 7.0 p 0.06), or in total milligram usage of ibuprofen (800 mg vs 610 mg, p = .62), acetaminophen (10000 mg vs 1300 mg, p = 0.62), and opioids (10 mg vs 15 mg, p = 0.51). Patients randomized to placebo were significantly more likely to be satisfied with their pain control (91% vs 75%, p = 0.02).

Patients receiving placebo were significantly more likely to rate their pain control as good or very good, compared to the DXM group (91% vs 75%, p = 0.02). While patient age was a differing factor between groups (25.8 vs 27.4, p < 0.05), dissatisfaction scores did not differ by patient age after adjustments (95% vs 71%, p = 0.01).

Of total patients, 124 (79%) opted to receive oxycodone prescriptions. Of those, 78 (63%) filled their prescriptions, and 6 of/156 (40%) reported taking any oxycodone during their medication abortion.

Patients who opted for an opioid prescription but did not get it filled reported lower rates of satisfaction in the DXM arm compared to placebo (70% vs 95% p = 0.03).

Investigators found worse pain scores and significantly less satisfaction in the DXM group overall, contrary to previous research that found DXM beneficial as an adjunctive option for gynecologic surgery.

“Given that patients do experience severe pain during this process, we should seek to improve patient use of ibuprofen, which is effective, and counsel patients on safe disposal of unused opioids,” the investigators concluded.

Reference

Ferguson GP, Achilles SL, Meyn LA, et al. Dextromethorphan as a novel nonopioid adjunctive agent for pain control with medication abortion: A randomized controlled trial. Contraception. Published online November 2022. doi:10.1016/j.contraception.2022.10.010