Physiological rationales of physical therapy interventions in the management of primary dysmenorrhea: a critical review

Abstract

Background: The mechanisms underlying the physical therapy interventions for obtaining relief from primary dysmenorrhea (PD) symptoms are not fully understood. Objective: To provide an overview of the physiological rationales from randomized controlled trials (RCTs) on how physical therapy interventions in the management of PD might work. Methods: Databases CINAHL, PEDro, Embase, Web of Science, Ovid Medline, and AMED were searched from database inception to October 2014 using related terms for dysmenorrhea and physical therapy interventions. Trials were independently selected and data extracted by two reviewers. Results: The search yielded 287 citations; 26 RCTs met the inclusion criteria and were included for review. Among the 26 included trials, eight trials on acupressure, seven on acupuncture, and five on TENS, two on spinal manipulation, one on low-level light therapy (LLLT), one on heat, one on far-infrared ray, and one on yoga were identified. The predominant physiological rationales identified in the RCTs are endogenous opioid mechanisms (n512), gate-control theory (n58), and traditional Chinese medicine (TCM) theory (n56). A few trials reported up to four different rationales. Conclusions: The analgesic effect of acupuncture is primarily through the release of endogenous opioids and hormones. In addition, practitioners of TCM believe that acupuncture alleviates pain of PD by regulating the prostaglandin levels. Acupressure, heat, high frequency transcutaneous electrical nerve stimulation (TENS), and yoga are proposed to work by segmental inhibition of pain pathway.

The effect of acupressure on pain level and hemodynamic parameters after coronary angiography: a randomized controlled study

“…This may increase the workload of the heart, the risk of complications, and may negatively affect the hospitalization process. It is important to implement painreducing interventions to prevent pain-related complications experienced by patients after CA (3,4). In addition to pharmacologic methods, such as non-opioid analgesics, nonsteroidal anti-inflammatory drugs, and opioid analgesics, nonpharmacologic methods can also be used to reduce pain (5,6).…”

“…The fact that pharmacologic methods have undesirable side effects such as hypotension, tachycardia, respiratory depression, constipation, nausea, and vomiting has led to an increase in the use of nonpharmacologic methods (aromatherapy, massage, acupuncture, acupressure, etc.) for treatment of pain control (4,7,8). Acupressure, one of these methods, is a body-based practice based on traditional Chinese medicine.…”

“…In the control of pain, studies have aimed to reduce the amount of analgesic use and stabilization of hemodynamic parameters by reducing the pain level through acupressure application (3,5,6,9,10). Since acupressure is a noninvasive, side-effect-free, safe, easy-to-apply, and effective method, its use is becoming increasingly widespread (3)(4)(5). In the literature, it has been reported that the most commonly used acupressure points in pain management are LI4, LI11, and PC6 (5,6,11,12).…”