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Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea

  • Alyssa Emo and Janice Blumer
Published/Copyright: July 1, 2018
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 118 Issue 7

Barassi G, Bellomo RG, Porreca A, Di Felice PA, Prosperi L, Saggini R. Somato-visceral effects in the treatment of dysmenorrhea: neuromuscular manual therapy and standard pharmacological treatment. J Altern Complement Med. 2018;24(3):291-299. doi:10.1089/acm.2017.0182

Primary dysmenorrhea, defined as pain at or just before the onset of menses without organic disease, is one of the leading causes of pelvic pain leading to absenteeism at work or school and decreased quality of life.1 The pain is caused by increased production of prostaglandins, which lead to increased uterine tone and subsequent uterine contractions.2 Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment,3 but some women prefer not to use pharmacotherapy (PT). Many studies have explored alternative pain relief methods, including acupuncture, acupressure, transcutaneous electrical nerve stimulation, and exogenous thermotherapy.4 Researchers at D'Annuzio University in Chieti, Italy, recently investigated whether neuromuscular therapy (NMT) is as effective as PT for managing primary dysmenorrhea.

Sixty women were included in the study based on the presence of primary dysmenorrhea without the presence of organic disease and a visual analog scale (VAS) score greater than 6 on a 10-point scale. Women were randomly assigned to group A (NMT) or B (PT), with 30 participants per group. Evaluation was performed at the start of the first menstrual cycle (T0) and the start of the subsequent cycle (T1) using the VAS to measure pain intensity, the Brief Pain Inventory Questionnaire to assess how activities of daily living were affected, and the Menstrual Distress Questionnaire to evaluate menstrual cycle characteristics and symptoms. Group A began treatment at T0 twice weekly for 1 month with direct myofascial techniques; group B was instructed to take an NSAID (specifically ibuprofen and/or naproxen) for symptomatic relief. An additional follow-up evaluation occurred at the start of the third menstrual cycle (T2) for 20 participants in group A to assess whether NMT provided any lasting effects.

Both treatment options had similar effects on improving pain intensity (P<.05 for both groups); however, the treatment type did not affect pain improvement (r2=0.008). Both treatments also improved the duration of pain (P<.05), but NMT had a significantly greater effect than PT in reducing duration (r2=0.491, P<.05). In the NMT follow-up group, VAS scores at T2 and T3 were not statistically different (W=0.95148, P=.2455). In terms of pain duration, there was a significant difference between means at all time points (W=0.85551, P=.2455).

This clinical trial demonstrates that both NMT and NSAIDs are effective treatment options for reducing intensity of pain in patients with primary dysmenorrhea. Neuromuscular therapy is superior in reducing intensity of pain over time compared with NSAIDs, but the treatment benefits do not extend to pain duration. For women with primary dysmenorrhea, NMT is an effective therapeutic alternative to PT.

Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon

References

1. Osayande AS , MehulicS. Diagnosis and initial management of dysmenorrhea [review]. Am Fam Physician. 2014;89(5):341-346.Search in Google Scholar

2. Bernardi M , LazzeriL, PerelliF, ReisFM, PetragliaF. Dysmenorrhea and related disorders. F1000Res. 2017;6:1645. doi:10.12688/f1000research.11682.1Search in Google Scholar PubMed PubMed Central

3. Marjoribanks J , AyelekeRO, FarquharC, ProctorM. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015;(7):CD001751. doi:10.1002/14651858.CD001751.pub3Search in Google Scholar PubMed PubMed Central

4. Proctor M , FarquharC. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332(7550):1134-1138.10.1136/bmj.332.7550.1134Search in Google Scholar PubMed PubMed Central

Published Online: 2018-07-01
Published in Print: 2018-07-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. LETTERS TO THE EDITOR
  2. Response
  3. OMT MINUTE
  4. Osteopathic Lymphatic Pump Techniques
  5. STILL RELEVANT?
  6. The Rule of the Artery Is Supreme. Or, Is It?
  7. LETTERS TO THE EDITOR
  8. Progressive Infantile Scoliosis Managed With Osteopathic Manipulative Treatment
  9. AOA COMMUNICATION (REPRINT)
  10. Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
  12. ORIGINAL CONTRIBUTION
  13. Medical Students’ Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors
  14. Lymphatic Pump Treatment Mobilizes Bioactive Lymph That Suppresses Macrophage Activity In Vitro
  15. JAOA/AACOM MEDICAL EDUCATION
  16. Oral Health Training in Osteopathic Medical Schools: Results of a National Survey
  17. CASE REPORT
  18. Perplexing Rash: Challenges to Diagnosis and Management of Mycosis Fungoides
  19. Laparoscopic Adjustable Gastric Band Erosion Into the Stomach and Colon
  20. THE SOMATIC CONNECTION
  21. Safety of Chiropractic Manipulation in Patients With Migraines
  22. Effect of HVLA on Chronic Neck Pain and Dysfunction
  23. Effects of Adding Cervicothoracic Treatments to Shoulder Mobilization in Subacromial Impingement Syndrome
  24. Manipulation Under Anesthesia Thaws Frozen Shoulder
  25. Treating Patients With Low Back Pain: Evidence vs Practice
  26. Reducing Low Back and Posterior Pelvic Pain During and After Pregnancy Using OMT
  27. Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea
  28. Reducing Cesarean Delivery Rates and Length of Labor by Addressing Pelvic Shape
  29. Remote MFR Increases Hamstring Flexibility: Support for the Fascial Train Theory
  30. CLINICAL IMAGES
  31. Minocycline-Induced Hyperpigmentation
  32. Massively Enlarged Leiomyomatous Uterus
https://doi.org/10.7556/jaoa.2018.109
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. LETTERS TO THE EDITOR
  2. Response
  3. OMT MINUTE
  4. Osteopathic Lymphatic Pump Techniques
  5. STILL RELEVANT?
  6. The Rule of the Artery Is Supreme. Or, Is It?
  7. LETTERS TO THE EDITOR
  8. Progressive Infantile Scoliosis Managed With Osteopathic Manipulative Treatment
  9. AOA COMMUNICATION (REPRINT)
  10. Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
  12. ORIGINAL CONTRIBUTION
  13. Medical Students’ Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors
  14. Lymphatic Pump Treatment Mobilizes Bioactive Lymph That Suppresses Macrophage Activity In Vitro
  15. JAOA/AACOM MEDICAL EDUCATION
  16. Oral Health Training in Osteopathic Medical Schools: Results of a National Survey
  17. CASE REPORT
  18. Perplexing Rash: Challenges to Diagnosis and Management of Mycosis Fungoides
  19. Laparoscopic Adjustable Gastric Band Erosion Into the Stomach and Colon
  20. THE SOMATIC CONNECTION
  21. Safety of Chiropractic Manipulation in Patients With Migraines
  22. Effect of HVLA on Chronic Neck Pain and Dysfunction
  23. Effects of Adding Cervicothoracic Treatments to Shoulder Mobilization in Subacromial Impingement Syndrome
  24. Manipulation Under Anesthesia Thaws Frozen Shoulder
  25. Treating Patients With Low Back Pain: Evidence vs Practice
  26. Reducing Low Back and Posterior Pelvic Pain During and After Pregnancy Using OMT
  27. Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea
  28. Reducing Cesarean Delivery Rates and Length of Labor by Addressing Pelvic Shape
  29. Remote MFR Increases Hamstring Flexibility: Support for the Fascial Train Theory
  30. CLINICAL IMAGES
  31. Minocycline-Induced Hyperpigmentation
  32. Massively Enlarged Leiomyomatous Uterus
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