The Somatic Connection  |   July 2018
Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon 
Article Information
The Somatic Connection   |   July 2018
Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 488-489. doi:
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 488-489. doi:
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. 
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Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015;(7):CD001751. doi: 10.1002/14651858.CD001751.pub3
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