SUMMARY POINTS

Pain perception includes both physical and psychosocial elements, and is best managed with both non-pharmacological and pharmacological techniques.
Studies show racial disparities in pain care, maternal morbidity and mortality, as well as disparities in pain management for people with substance use disorder, raising important opportunities for clinicians to pause and evaluate their own biases.
Non-pharmacological methods of pain management offer multi-modal options for pain control that allow for individualized care at low-risk.
Paracervical block helps reduce pain, and there are many variations on technique.
Oral NSAIDs, anxiolytics, or opioids may be given individually or together prior to uterine aspiration, although the latter may cause nausea with limited benefit.
Intravenous pain management may be chosen if monitoring and staffing are available; patients may require provision of respiratory support.
Individuals who regularly use opioids or have opioid use disorder on medication assisted therapy should continue their medications prior to a procedure, and may require higher doses of pain medications. Substance use should not impact a clinician’s usual assessment of capacity for informed consent.

Universal pre-procedure antibiotic prophylaxis for uterine aspiration is well supported by the available evidence.
Attention to allergies, concurrent medications, conditions that compromise respiratory status, recommended dose limits, and reversal agents will improve safety.
Emergency management simulations and supplies should be regularly reviewed.

Participation in decisions around the procedure, gentle procedural technique, deep-breathing techniques, distraction through conversation, the support of a partner, friend, doula, or medical assistant, and a reassuring tone of voice will all be helpful in addition to pain medication.

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