Comparison of Ibuprofen with Ibuprofen plus Transcutaneous Electrical Nerve stimulation in pain reduction of induced first trimester abortion with misoprostol

Document Type : Original Article


1 Professor, Department of Obstetrics and Gynecology, Taleghani Hospital Clinical Development Research Unit, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Associate Professor, Department of Anesthesiology, Anesthesiology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.


Introduction: Most women who undergo first trimester medical abortion experience abdominal pain and cramps. The present study was performed aimed to evaluate the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on reducing the pain of induction of abortion in the first trimester of pregnancy.
Methods: In this single-blind clinical trial which was performed in 2020-2021, for 40 women in the first trimester of pregnancy who were candidate for medical abortion with misoprostol in order to reduce pain, randomly administered Ibuprofen and inactive TENS or Ibuprofen and active TENS with a frequency of 80 Hertz and intensity of 0 to 80 milliampere to reduce pain. These two groups were compared in terms of pain intensity before and after the use of TENS, the amount of used Ibuprofen, satisfaction from the process of medical abortion and complications. Data were analyzed by SPSS (version 16) and Chi-square and Mann-Whitney statistical tests. P<0.05 was considered statistically significant.
Results: In the active TENS group, the use of ibuprofen was significantly lower (P= 0.001) and pain reduction was significantly higher (P= 0.001) than the other group. Also in this group, satisfaction with the abortion process was higher (P=0.044).
Conclusion: In patients who are hospitalized for medical abortion in the first trimester of pregnancy, in addition to Ibuprofen, TENS can be used for further relief.



    1. Winikoff B, Sivin I, Coyaji KJ, Cabezas E, Bilian X, Sujuan G, et al. Safety, efficacy, and acceptability of medical abortion in China, Cuba, and India: a comparative trial of mifepristone-misoprostol versus surgical abortion. American journal of obstetrics and gynecology 1997; 176(2):431-7.
    2. Jones RK, Jerman J. Abortion incidence and service availability in the United States, 2014. Perspectives on sexual and reproductive health 2017; 49(1):17-27.
    3. Ngoc NT, Blum J, Raghavan S, Nga NT, Dabash R, Diop A, et al. Comparing two early medical abortion regimens: mifepristone+ misoprostol vs. misoprostol alone. Contraception 2011; 83(5):410-7.
    4. Suhonen S, Tikka M, Kivinen S, Kauppila T. Pain during medical abortion: predicting factors from gynecologic history and medical staff evaluation of severity. Contraception 2011; 83(4):357-61.
    5. Goldman AR, Porsch L, Hintermeister A, Dragoman M. Transcutaneous electrical nerve stimulation to reduce pain with medication abortion: a randomized controlled trial. Obstetrics & Gynecology 2021; 137(1):100-7.
    6. Livshits A, Machtinger R, David LB, Spira M, Moshe-Zahav A, Seidman DS. Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study. Fertility and sterility 2009; 91(5):1877-80.
    7. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain management 2014; 4(3):197-209.
    8. Simpson PM, Fouche PF, Thomas RE, Bendall JC. Transcutaneous electrical nerve stimulation for relieving acute pain in the prehospital setting: a systematic review and meta-analysis of randomized-controlled trials. European Journal of Emergency Medicine 2014; 21(1):10-7.
    9. de Sousa L, Gomes‐Sponholz FA, Nakano AM. Transcutaneous electrical nerve stimulation for the relief of post‐partum uterine contraction pain during breast‐feeding: A randomized clinical trial. Journal of Obstetrics and Gynaecology Research 2014; 40(5):1317-23.
    10. Lisón JF, Amer-Cuenca JJ, Piquer-Martí S, Benavent-Caballer V, Biviá-Roig G, Marín-Buck A. Transcutaneous nerve stimulation for pain relief during office hysteroscopy. Obstetrics & Gynecology 2017; 129(2):363-70.
    11. Proctor M, Farquhar C, Stones W, He L, Zhu X, Brown J. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002(1).
    12. Njogu A, Qin S, Chen Y, Hu L, Luo Y. The effects of transcutaneous electrical nerve stimulation during the first stage of labor: a randomized controlled trial. BMC Pregnancy and Childbirth 2021; 21(1):1-8.
    13. Báez-Suárez A, Martín-Castillo E, García-Andújar J, García-Hernández JÁ, Quintana-Montesdeoca MP, Loro-Ferrer JF. Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials 2018; 19(1):1-0.
    14. Platon B, Andréll P, Raner C, Rudolph M, Dvoretsky A, Mannheimer C. High-frequency, high-intensity transcutaneous electrical nerve stimulation as treatment of pain after surgical abortion. Pain 2010; 148(1):114-9.
    15. Lerma K, Goldthwaite LM, Blumenthal PD, Shaw KA. Transcutaneous electrical nerve stimulation (TENS) for pain control during first-trimester abortion: A single-blinded randomized controlled trial. Contraception 2020; 101(5):357.
    16. Payandeh M, Nahidi F, Nasiri M, Fouladi A. Comparing the effects of transcutaneous electrical nerve stimulation and pharmaceutical hyoscine–promethazine compound on duration of second phase of labor. Iran J Obstet Gynecol Infertil 2019; 22(8):19-25.
    17. Johnson M. Transcutaneous electrical nerve stimulation: mechanisms, clinical application and evidence. Reviews in pain 2007; 1(1):7-11.