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The Somatic Connection  |   March 2015
Dramatic Reduction in Menstrual Pain After Osteopathic Manipulative Therapy
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   March 2015
Dramatic Reduction in Menstrual Pain After Osteopathic Manipulative Therapy
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 170-171. doi:10.7556/jaoa.2015.033
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 170-171. doi:10.7556/jaoa.2015.033
Schwerla F, Wirthwein P, Rütz M, Resch KL. Osteopathic treatment in patients with primary dysmenorrhea: a randomized controlled trial. Int J Osteopath Med. 2014;17:222-231. doi:10.1016/j.ijosm.2014.04.003.  
Researchers in Germany used a pragmatic design to assess the effect of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) on women with diagnosed primary dysmenorrhea (N=60). Inclusion criteria were age 14 years or older and “regular menstrual cycle (± 10 days).” Exclusion criteria were contraceptive use, being pregnant, reported substance abuse, hormonal therapy, neurologic abnormalities, or a diagnosis of secondary dysmenorrhea. Participants were randomly assigned to an OMTh group (N=25) or a control (no intervention) group (N=28). 
Osteopathic evaluation and OMTh were carried out by 3 osteopaths who were registered naturopaths. Patients in the OMTh group received 6 therapy sessions delivered twice per menstrual cycle for 3 successive cycles. In each session, OMTh was applied to only those structures in which somatic dysfunction was present. 
Outcome measures included a numerical rating scale (NRS), with 0 indicating no pain and 10 indicating worst pain imaginable, and a health-related quality of life questionnaire, the Short Form (SF)-36. Duration of menstrual pain was also measured by recording the number of days patients reported general pain and the number of days patients reported intense pain (ie, ≥5 on the NRS). Whereas measures for the OMTh group were collected at each session, participants in the control group filled out the SF-36 and NRS for duration and intensity of pain once per menstrual cycle and mailed in their data. At baseline, no statistically significant differences were noted between groups for any outcome measure. 
Results were significant for reduction of pain intensity in the OMTh group, with mean (SD) NRS scores of 4.6 (1.2) before intervention and 1.9 (1.4) after intervention (P<.0005). The mean (SD) reported days of general pain was also significantly reduced in this group (4.5 [1.8] days before intervention to 2.2 [1.8] after intervention; P<.0005), as was reported duration of intense pain (2.2 [1.4] days before intervention to 0.2 [0.6] days after intervention; P<.0005). No changes in these measures were observed for the control group. The physical component score on the SF-36 showed significant improvement for the OMTh group (P<.003) but not for the control group. 
The pragmatic “treat what you find” study design produced dramatic reduction in the symptoms of primary dysmenorrhea, although it has not been used in many osteopathic research projects. The researchers planned for this study to test the value of seeking help from an osteopath (ie, the perceived effectiveness rather than the effectiveness of particular osteopathic techniques). I believe this approach to research design has a promising future in the osteopathic medical profession.