title: Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review.
abstract: OBJECTIVE
  In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life?
  
  
  METHODS
  Systematic review of randomised trials with meta-analysis.
  
  
  METHODS
  Women with primary dysmenorrhea.
  
  
  METHODS
  Any form of physiotherapy treatment.
  
  
  METHODS
  The primary outcome was menstrual pain intensity and the secondary outcome was quality of life.
  
  
  RESULTS
  The search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0-10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0-10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life.
  
  
  CONCLUSIONS
  Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects.
authors.affiliation: Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand.
authors.forename: Priya
authors.initials: P
authors.lastname: Kannan
authors.affiliation: Department of Allied Health and Medicine, Anglia Ruskin University, Chelmsford, UK.
authors.forename: Leica Sarah
authors.initials: LS
authors.lastname: Claydon
mesh_terms: D019050:Acupressure; D026881:Acupuncture; D000293:Adolescent; D000328:Adult; D004412:Dysmenorrhea / Q000628:therapy*; D004599:Electric Stimulation Therapy; D005260:Female; D006358:Hot Temperature; D006801:Humans; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016896:Treatment Outcome; D015013:Yoga; D055815:Young Adult
keywords: Dysmenorrhea; Physical therapy modalities; Primary dysmenorrhea; Systematic review