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Effects of Osteopathic Manipulative Treatment on Primary Dysmenorrhea
Companion, N. [5]
Ahmed, E. [2]
Keys, J. [12]
Abu-Sbaih, R. [16]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A76-A78. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

dysmenorrhea [18]
female [379]
OMT [2951]
osteopathic manipulative treatment [2973]
pretest posttest design [108]
women [333]

Abstract:

Statement of Significance: Primary Dysmenorrhea affects 45-90% of females with varying severity. With increasing severity, daily activities are affected; in one study, 38% of women were not able to perform their regular daily activities. Current treatment options are limited to NSAIDs (non-steroidal anti-inflammatory drugs) and oral contraceptive pills (OCPs). OMT may provide an additional treatment option to reduce menstrual pain and symptoms. Research Methods: This is a prospective intervention, with A-B-A design, utilizing survey data and muscle measurements. Females over the age of 18 diagnosed with primary dysmenorrhea not attributed to a physiologic cause and not treated with any form of birth control were included. Five female subjects (ages 20-25) suffering from menstrual-related pain participated. Subjects completed a validated survey, Menstrual Distress Questionnaire (MDQ), to gather subjective symptoms during three consecutive menstrual cycles: control, treatment, and follow-up. The MDQ was filled out at three time points of each cycle: premenstrual, menstrual, and postmenstrual. The MDQ is divided into four sub-sections: pain, water retention, autonomics, and negative affect. Each subject’s first complete menstrual cycle acted as a control to gather baseline symptom duration and severity, in which no OMT interventions were made. During the second menstrual cycle, paraspinal muscles at L1 and L3 bilaterally were measured prior to and after each treatment session. The MyotonPRO measured tone, stiffness, decrement, creep, and relaxation of erector spinae muscle. A team of three board-certified osteopathic physicians performed osteopathic structural exams and treated subjects 6-8 times throughout the second menstrual cycle, using a systematic and uniform OMT protocol.The treatment protocol applied principles of OMT to free tissue tension and promote adequate blood and lymphatic flow in order to remove inflammatory mediators, leading to relief in back and suprapubic pain. OMT was done in regions of sympathetic innervation to the Gastrointestinal and Genitourinary systems to relieve diarrhea, nausea, and vomiting. OMT targeting the sacral nerve roots and vagus nerve was done to improve parasympathetic innervation to GI and GU systems. After addressing these regions, OMT could lead to an overall psychological improvement in the subject’s energy level and mood. Data Analysis/Results: MyotonPRO data was analyzed from 124 unique measurements using paired t-tests with SPSS statistical software.The tone significantly decreased after OMT (13.9242 ± 1.7 Hz) compared to prior to treatment (14.2048 ± 1.6 Hz), p=0.004, with a power=0.898.The stiffness significantly decreased after OMT (235.2581 ± 73.4 N/m) compared to prior to treatment (247.1613 ± 66.5 N/m), p<0.001, with a power=0.961.The decrement (1/elasticity) significantly decreased after OMT (1.0772 ± 0.27) compared to prior to treatment (1.1278 ± 0.29), p=0.001, with power=0.948. However, relaxation and creep did not show statistically significant differences from prior to post-OMT (p= 0.223, p=0.133).Survey data of 45 responses from 5 subjects over 3 cycles was analyzed using repeated measures ANOVA using SPSS statistical software. Raw scores were totaled from each sub-section and converted to standard T-scores to permit comparison within and across cycle phases and between females.The pain score at baseline (64.6 ±17.8) was significantly reduced to 47.67 ± 8.75 during the treatment cycle, as well as the follow-up cycle (52.4 ± 12.25), (F(2,28)=9.543, p<0.001), which was statistically significant.The water retention score at baseline (65 ± 23.15), was improved during the treatment cycle (50.067 ± 16), and follow-up cycle (52.6 ± 20.3). (F(2,28)=4.162, p=0.026), which was statistically significant. The negative affect score at baseline (48.2 ± 13.3), improved during the treatment cycle (40.267 ± 5), as well as during the follow-up cycle (41.13 ± 10.4), (F(2,28)=4.086, p=0.028), which was statistically significant.The autonomics score at baseline (47.867 ± 8.2) trended down to 44 ± 3.3 and 44.73 ± 3.95; however, this change was not statistically significant, (F(2,28)=2.359, p=0.113.). Conclusion: This study demonstrated that OMT can be used to address primary dysmenorrhea and the debilitating effects that females experience each month. OMT significantly reduced pain, water retention, and negative affect associated symptoms’ duration and intensity. OMT can provide relief to patients, is a non-invasive method, and has minimal to none adverse effects. OMT can also potentially treat those that cannot use NSAIDs or OCPs for medical or financial reasons. In choosing to measure the lumbar paraspinal muscles at L1 and L3, this study showed muscle changes which may correlate with viscerosomatic sympathetic reflex changes associated with the uterus. OMT significantly decreased the stiffness, tone, and decrement of the lumbar erector spinae at these levels. Limitations of this study are a small sample size, variability of treating physicians, as well as variability in cycle lengths and symptoms experienced. This suggests further study in this area is warranted.

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