Pain of first-trimester abortion: a study of psychosocial and medical predictors

Pain during first-trimester abortion by suction-curettage under local anesthesia alone was measured with the McGill Pain Questionnaire (MPQ), and verbal and visual analogue scales in 109 women. The average intensity of abortion pain ranked among moderately intense pain recorded with the MPQ. However, the pain scores had a wide range and appeared influenced by several demographic, psychosocial and medical variables. A correlation/stratified multiple regression design was used to examine the sources of individual variability in pain reports. The results indicated that over a third of the variance in pain reports could be predicted by a set of variables which included the patient's age, self-reports of pre-operative depression, anxiety, fear, low pain tolerance, social and moral concerns, and gynecological characteristics such as uterus retroversion, menstrual pain and gestational age. Pain scores were significantly higher for women who reported moderate to severe levels of pre-abortion depression and for younger patients (13-17 years); other psychosocial and gynecological features made small additional contributions to the prediction of pain scores. The implications of the results are discussed in relation to pain management strategies and underscore the special needs of each woman facing an abortion.