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de Arruda GT, Driusso P, de Godoy AG, de Sousa AP, Avila MA. Measurement properties of patient-reported outcome measures for women with dysmenorrhea: A systematic review. J Clin Nurs 2024; 33:4167-4183. [PMID: 38797927 DOI: 10.1111/jocn.17293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive. AIM To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea. METHODS The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines. RESULTS Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent. CONCLUSIONS The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology. PATIENT OR PUBLIC CONTRIBUTION Not applicable as this is a systematic review. TRIAL REGISTRATION PROSPERO protocol: CRD42021244410. Registration on April 22, 2021.
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Affiliation(s)
- Guilherme Tavares de Arruda
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Post-Graduate Program and Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Patricia Driusso
- Laboratory of Research on Women's Health (LAMU), Physical Therapy Post-Graduate Program and Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Amanda Garcia de Godoy
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Post-Graduate Program and Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Ana Paula de Sousa
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Post-Graduate Program and Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Post-Graduate Program and Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
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Payne LA, Seidman LC, Granger SW, Edelman A, Ren B. A Prospective Study of the Relationship of COVID-19 Vaccination to Menstrual Cycle Characteristics in Adolescent Girls. J Adolesc Health 2024:S1054-139X(24)00307-0. [PMID: 39152975 DOI: 10.1016/j.jadohealth.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE The current study aimed to evaluate the impact of the COVID-19 booster vaccine on menstrual cycle characteristics in adolescent girls (aged 13-20) compared to those who did not receive a booster vaccine. METHODS This prospective study measured menstrual cycle length for three cycles prior to and four cycles after vaccination (booster group), seven cycles without vaccination (control group). Menstrual flow, menstrual pain, and menstrual symptoms were assessed at baseline and monthly for 3 months. Stress was assessed at baseline using the PROMIS Pediatric Psychological Stress Experiences scale. Generalized linear mixed effects models were used to examine the changes in menstrual characteristics. RESULTS 65 adolescent girls (47 booster; 18 control) were recruited via social media and from ongoing studies in the United States. Girls in the booster group experienced shorter postbooster cycles by an average 5.35 days (p = .03) compared to prebooster cycle lengths, specifically in the second postbooster cycle, while the control group did not show any changes in cycle length pre-to postbooster. Participants who received the booster in the follicular phase had shorter mean postbooster cycle length (p = .0157) compared to their prebooster cycle length. Higher stress was associated with shorter cycles (p = .03) and increased menstrual symptoms (p = <.001), regardless of group. There were no differences in menstrual flow, menstrual pain, or menstrual symptoms in either group. DISCUSSION The COVID-19 booster vaccine was associated with shorter cycles in adolescent girls. These data demonstrate the need for further investigation regarding potential mechanisms of these observed changes.
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Affiliation(s)
- Laura A Payne
- McLean Hospital, Belmont, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | | | | | - Boyu Ren
- McLean Hospital, Belmont, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Snipe RMJ, Brelis B, Kappas C, Young JK, Eishold L, Chui JM, Vatvani MD, Nigro GMD, Hamilton DL, Convit L, Carr A, Condo D. Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: Systematic literature review and meta-analysis. Nutr Diet 2024; 81:94-106. [PMID: 37545015 DOI: 10.1111/1747-0080.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
AIM This systematic literature review with meta-analysis aimed to determine the effect of omega-3 long chain polyunsaturated fatty acids on prostaglandin levels and pain severity in women with dysmenorrhoea and identify adverse side effects. METHODS A literature search was conducted in Embase, Scopus, Web of Science, MEDLINE complete, CINAHL and AMED databases (PROSPERO CRD42022340371). Included studies provided omega-3 long chain polyunsaturated fatty acids compared to a control in women with dysmenorrhoea and reported pain and/or prostaglandin levels. A random effects meta-analysis with Cohen's d effect size (95% confidence interval) was performed in SPPS for studies that reported pain outcomes. Study quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. RESULTS Twelve studies (n = 881 dysmenorrhoeal women) of predominantly neutral quality (83%) were included that provided daily supplementation of 300-1800 mg omega-3 long chain polyunsaturated fatty acids over 2 or 3 months. Meta-analysis (n = 8 studies) showed a large effect of omega-3 long chain polyunsaturated fatty acids (d = -1.020, 95% confidence interval -1.53 to -0.51) at reducing dysmenorrhoea pain. No studies measured prostaglandin levels, 86% of studies measuring analgesic use showed a reduction with omega-3 long chain polyunsaturated fatty acids and few studies reported mild adverse side effects in individual participants. CONCLUSIONS Findings suggest that daily supplementation of 300-1800 mg omega-3 long chain polyunsaturated fatty acids over 2-3 months are generally well tolerated and reduces pain and analgesic use in women with dysmenorrhoea. However, the neutral quality of research is limited by methodological issues and the mechanism of action remains to be determined.
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Affiliation(s)
- Rhiannon M J Snipe
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Benjamin Brelis
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Christina Kappas
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Julie K Young
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Lucy Eishold
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Jie M Chui
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Meher D Vatvani
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Gabriella M D Nigro
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - D Lee Hamilton
- School of Exercise and Nutrition Science, Deakin University, Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Lilia Convit
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Amelia Carr
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Dominique Condo
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Handy AB, Seidman LC, Payne LA. Development and initial validation of the menstrual sensitivity index. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:78-85. [PMID: 37688582 PMCID: PMC10765159 DOI: 10.1093/pm/pnad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE The present study sought to develop and perform the initial validation of a scale assessing sensitivity to menstrual pain and symptoms. METHODS Data were taken from a larger parent study in which participants were recruited from a nationwide sample of individuals via the UniVox platform (www.univoxcommunity.com). In that study, participants were stratified by age and self-reported menstrual pain. Participants in the parent study completed 2 online surveys, one at baseline and one at a 3-month follow up. Participants who provided complete responses to the potential scale items, as well as a variety of validated questionnaires, were included in the present analyses. Final item selection was determined by factor analyses, and measures of validity and reliability were examined. RESULTS Factor analyses support an 8-item scale assessing menstrual sensitivity. This scale, the Menstrual Sensitivity Index, demonstrates excellent internal consistency, good item-total correlations, and good total score test-retest reliability. Convergent validity emerged for menstrual- and pain-specific measures, and divergent validity emerged for anxiety sensitivity, anxiety, depression, nonmenstrual bodily pain, and premenstrual symptoms. CONCLUSIONS Menstrual sensitivity is a unique construct that reflects women's attunement to and fear of menstrual symptoms, and the Menstrual Sensitivity Index is a valid and reliable measure of this construct. This scale could be useful in advancing research and clinical work targeting menstrual pain.
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Affiliation(s)
| | | | - Laura A Payne
- McLean Hospital, Belmont, MA 02478, United States
- Harvard Medical School, Boston, MA 02115, United States
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Piontek K, Gabes M, Kann G, Fechtner M, Apfelbacher C. Quality of patient-reported outcome measures for primary dysmenorrhea: a systematic review. Qual Life Res 2024; 33:31-43. [PMID: 37902914 PMCID: PMC10784326 DOI: 10.1007/s11136-023-03517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To conduct a systematic review of the quality of patient-reported outcome measures (PROMs) for primary dysmenorrhea (PDys) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the PROMs. METHODS We searched PubMed and Web of Science for studies reporting on the development and/or validation of any PROMs for women with PDys. Applying the COSMIN Risk of Bias Checklist, we assessed the methodological quality of each included study. We further evaluated the quality of measurement properties per PROM and study according to the criteria for good measurement properties, and graded the evidence. Based on the overall evidence, we derived recommendations for the use of the included PROMs. RESULTS Data from seven studies reporting on four PROMs addressing different outcomes were included. Among those, the Adolescent Dysmenorrhic Self-Care Scale (ADSCS) and the on-menses version of the Dysmenorrhea Symptom Interference Scale (DSI) can be recommended for use. The Exercise of Self-Care Agency Scale (ESCAS) and the Dysmenorrhea Daily Diary (DysDD) have the potential to be recommended for use, but require further validation. The off-menses version of the DSI cannot be recommended for use. CONCLUSIONS The ADSCS can be recommended for the assessment of self-care behavior in PDys. Regarding measures of impact, the on-menses version of the DSI is a suitable tool. Covering the broadest spectrum of outcomes, the DysDD is promising for use in medical care and research, encouraging further investigations. Further validation studies are indicated for all included PROMs.
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Affiliation(s)
- Katharina Piontek
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Gesina Kann
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Marie Fechtner
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Li X, Zhang B, Tan P, Chesney MA, Zhang T, Nie G. The cross-cultural adaptation and psychometric properties of the menstrual symptom questionnaire (MSQ) among Chinese women of reproductive age. Heliyon 2023; 9:e20450. [PMID: 37810819 PMCID: PMC10556762 DOI: 10.1016/j.heliyon.2023.e20450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Objective This study reports on a translation of the Menstrual Symptom Questionnaire (MSQ) into Chinese, a cross-cultural adaptation among Chinese women of reproductive age, and an assessment of its reliability and validity. Methods Previously published translation guidelines were followed to translate and cross-culturally adapt the English version of MSQ to produce a Chinese version. This Chinese version was then administered to 2800 Chinese women of reproductive age recruited by convenience sampling method. The reliability of the Chinese MSQ was tested for internal consistency and test-retest reliability. The concurrent and construct validity of the questionnaire was evaluated using correlation and factor analysis. Results The Chinese version of the MSQ showed no linguistic or semantic issues. The internal consistency of the Chinese MSQ Cronbach'α = 0.912, and the test-retest reliability r = 0.911. The exploratory factor analysis identified four factors. The confirmatory factor analysis demonstrated that the four factor structure of the Chinese version of the MSQ (Pain Experience, Emotional Changes, Pain Coping Strategies, and Other Physical Symptoms) is reasonable among Chinese women of reproductive age. There was a significant correlation found between these four factors and both the Pittsburgh Sleep Quality Index and the SF-8 Health Survey. Conclusion The Chinese version of the MSQ achieved semantic equivalence in translation and demonstrated good reliability and validity among Chinese women of reproductive age. Thus, it can serve as an effective tool to assess the experience of menstrual symptoms among Chinese women.
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Affiliation(s)
- Xiuxia Li
- Guangxi Medical University, Nanning 530021, China
| | | | - Peixuan Tan
- Guangxi Medical University, Nanning 530021, China
| | - Margaret A. Chesney
- Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA
| | | | - Guanghui Nie
- Guangxi Medical University, Nanning 530021, China
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Deodato M, Grosso G, Drago A, Martini M, Dudine E, Murena L, Buoite Stella A. Efficacy of manual therapy and pelvic floor exercises for pain reduction in primary dysmenorrhea: A prospective observational study. J Bodyw Mov Ther 2023; 36:185-191. [PMID: 37949558 DOI: 10.1016/j.jbmt.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/28/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Primary dysmenorrhea represents one of the most common causes of pelvic and low back pain. Pharmacological treatment can present some side effects, and non-pharmacological treatments should be considered to improve the symptoms of primary dysmenorrhea. The aim of this study was to evaluate the efficacy of manual therapy (MT), pelvic floor exercises (PFE), and their combination (MT + PFE) to improve clinical outcomes and pain sensitivity in women with primary dysmenorrhea. METHODS A prospective observational study was conducted. Thirty females (age 25.0 ± 6.1 y) with history of primary dysmenorrhea participated to 8 sessions of 60 min of either MT, PFE or MT + PFE, twice per week. They participated to the different treatments according to the different services offered by the school of physiotherapy. A 0-10 numeric rating scale (NRS) was administered to assess subjective pain, while short-form 36 (SF-36) was used to evaluate quality of life. The pressure pain threshold (PPT) was assessed with a portable algometer on different pelvic and lumbar areas. RESULTS Independently from the treatment, significant improvements were reported for general pain NRS (p < 0.001; pη2 = 0.511), as well as most the domains of the SF-36, although the general health domain did not reach statistical significance (p = 0.613; pη2 = 0.010). PPT revealed a general improvement in all tested body areas, although on the quadratus lumborum, the PFE treatment did not induce a significant improvement compared to the MT and MT + PFE protocols (p = 0.039). CONCLUSIONS These findings highlight the importance of proposing physiotherapy treatments to females with primary dysmenorrhea to improve symptoms, with manual therapy combined with active pelvic floor exercise providing the best outcomes including an improvement of lumbar pain thresholds.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Giulia Grosso
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Alice Drago
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Erica Dudine
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy; Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy.
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Rogers SK, Galloway A, Hirsh AT, Zapolski T, Chen CX, Rand KL. Efficacy of psychological interventions for dysmenorrhea: a meta-analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1086-1099. [PMID: 37154693 DOI: 10.1093/pm/pnad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.
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Affiliation(s)
- Sarah K Rogers
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Amanda Galloway
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Tamika Zapolski
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN 46202, United States
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
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Jeong D, Lee H, Kim J. Effects of sleep pattern, duration, and quality on premenstrual syndrome and primary dysmenorrhea in korean high school girls. BMC Womens Health 2023; 23:456. [PMID: 37641079 PMCID: PMC10464156 DOI: 10.1186/s12905-023-02600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Sleep deprivation is known to be a risk factor for premenstrual syndrome and primary dysmenorrhea in adults. However, it has rarely been investigated in adolescents. The aim of this study was to investigate whether sleep pattern, duration, and quality independently affect premenstrual syndrome and primary dysmenorrhea in adolescent girls. An additional purpose was to investigate the sleep status in Korean adolescent girls during the COVID-19 pandemic. METHODS A cross-sectional survey study was conducted in 519 high school girls aged 15 to 18 years in Gyeonggido, South Korea, in 2021 during the COVID-19 lockdown. Menstrual pain intensity and menstrual symptoms were assessed using the visual analogue scale (VAS) and Cox menstrual symptom scale (CMSS), respectively. Premenstrual syndrome was assessed by the premenstrual symptoms screening tool (PSST). Sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI). The known risk factors of dysmenorrhea, including menstrual and lifestyle characteristics and stress, were assessed as covariates. RESULTS During the pandemic, approximately 68% of girls slept 7 h or less, while about 60% reported poor sleep quality. Additionally, 64% of participants had a bedtime later after 1AM, and 34% woke up later after 8AM. Late bedtime significantly affected VAS (P = 0.05), CMSS severity and frequency (both P < 0.01), and PSST symptom (P < 0.01). Waking up late affected CMSS severity (P < 0.05), PSST symptom (P = 0.05), and PSST function (P < 0.05). However, the significance of these effects disappeared after controlling for covariates. Sleeping less than 5 h affected CMSS frequency (P < 0.05) and PSST symptoms (P < 0.001). After controlling for covariates, the significance of the effect on PSST symptom remained (P < 0.05). General sleep quality and PSQI components, including subjective sleep quality, sleep latency, sleep disturbance, use of sleeping medication, and daytime dysfunction, significantly affected CMSS frequency and severity and PSST symptom after controlling for covariates (P < 0.05, P < 0.01, or P < 0.001). The multiple regression analysis revealed that among sleep characteristics, sleep quality was the most important risk factor of premenstrual syndrome and dysmenorrhea. CONCLUSION Our study result heightens the importance of healthy sleep hygiene, especially sleep quality in the management of premenstrual syndrome and dysmenorrhea in adolescent girls.
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Affiliation(s)
- Daye Jeong
- Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), 24, Kyonggidae- ro 9-gil, Seodaemun-gu, Seoul, 03746, Republic of Korea
| | - Heakyong Lee
- Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), 24, Kyonggidae- ro 9-gil, Seodaemun-gu, Seoul, 03746, Republic of Korea
| | - Jaehee Kim
- Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), 24, Kyonggidae- ro 9-gil, Seodaemun-gu, Seoul, 03746, Republic of Korea.
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Song BH, Kim J. Effects of Pilates on Pain, Physical Function, Sleep Quality, and Psychological Factors in Young Women with Dysmenorrhea: A Preliminary Randomized Controlled Study. Healthcare (Basel) 2023; 11:2076. [PMID: 37510517 PMCID: PMC10379070 DOI: 10.3390/healthcare11142076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
The effect of Pilates on dysmenorrhea has been little studied. The purpose of this study was to evaluate the effect of Pilates on menstrual pain and symptoms, premenstrual syndrome, and risk factors of dysmenorrhea. Thirty young women with primary dysmenorrhea were randomly assigned into a Pilates group (PG; n = 15) and a waitlist control group (CG; n = 15). The Pilates was performed twice a week for 12 weeks. Menstrual pain and symptoms were measured by visual analogue scale (VAS) and the Cox menstrual symptom scale (CMSS), respectively. Premenstrual syndrome was assessed using the premenstrual symptoms screening tool (PSST). Additionally, back flexibility, hip muscle strength, sleep duration and quality, perceived stress, state-trait anxiety, and depression were evaluated. The VAS, CMSS severity and frequency, and PSST symptoms and functional impairments decreased in the PG compared to the CG (p < 0.001 or p < 0.01) with large effect sizes. Back flexibility and the strength of hip flexors, hip extensors, and hip abductors significantly increased in the PG compared to the CG (all p < 0.01) with large effect sizes. Sleep quality (p < 0.01) and stress (p < 0.05) improved in the PG. Sleep duration, anxiety, and depression did not change in either group. In conclusion, the 12-week Pilates intervention ameliorates dysmenorrhea, partly mediated by improved physical function and sleep quality.
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Affiliation(s)
- Bo-Hwa Song
- Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), 24, Kyonggidae-ro 9-gil, Seodaemun-gu, Seoul 03746, Republic of Korea
| | - Jaehee Kim
- Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), 24, Kyonggidae-ro 9-gil, Seodaemun-gu, Seoul 03746, Republic of Korea
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Payne LA, Seidman LC, Ren B, Greenfield SF. COVID-Related Distress Is Associated with Increased Menstrual Pain and Symptoms in Adult Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:774. [PMID: 36613098 PMCID: PMC9819102 DOI: 10.3390/ijerph20010774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic resulted in heightened stress for many individuals, with women reporting more stress than men. Although a large body of evidence has demonstrated that stress, in general, can impact the menstrual cycle, it is not yet clear if COVID-specific stress would impact women's menstrual health. The current study explored the relationship between COVID-related stress and distress and menstrual variables (menstrual pain, number and severity of menstrual symptoms, and menstrual pain interference) in a sample of reproductive-age adult women. Seven-hundred fifteen women completed the initial survey and were re-contacted to complete the same survey three months later. Of those recontacted, 223 completed the follow-up survey. Results indicated that COVID-related stress and distress was associated with higher levels of menstrual pain, more frequent and more severe menstrual symptoms, and greater menstrual pain interference, even after accounting for age, hormonal use, bodily pain, and pain catastrophizing. Our findings suggest that women experience unique vulnerabilities that directly impact their health and functioning, and both research and clinical care should address these symptoms through careful assessment and treatment of menstrual pain and symptoms, particularly during and after periods of high stress and distress.
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Affiliation(s)
- Laura A. Payne
- McLean Hospital, Belmont, MA 02478, USA
- Harvard Medical School, Boston, MA 02115, USA
| | | | - Boyu Ren
- McLean Hospital, Belmont, MA 02478, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Shelly F. Greenfield
- McLean Hospital, Belmont, MA 02478, USA
- Harvard Medical School, Boston, MA 02115, USA
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12
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Rodrigues JC, Avila MA, dos Reis FJJ, Carlessi RM, Godoy AG, Arruda GT, Driusso P. ‘Painting my pain’: the use of pain drawings to assess multisite pain in women with primary dysmenorrhea. BMC Womens Health 2022; 22:370. [PMID: 36071417 PMCID: PMC9449259 DOI: 10.1186/s12905-022-01945-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background To verify the use of pain drawing to assess multisite pain in with primary dysmenorrhea (PD) and to assess its divergent validity, test–retest reliability, intra- and inter-rater reliability and measurement errors.
Methods Cross-sectional study. Adult women with self-reported PD three months prior to the study. Women answered the Numerical Rating Scale (NRS) and the pain drawing during two consecutive menstruations. The pain drawings were digitalized and assessed for the calculation of total pain area (%). Intra- and inter-rater reliability and the test–retest reliability between the first and the second menstruations were assessed with the intraclass correlation coefficient (ICC). Measurement errors were calculated with the standard error of measurement (SEM), smallest detectable change (SDC) and the Bland–Altman plot. Spearman correlation (rho) was used to check the correlation between the total pain area and pain intensity of the two menstruations.
Results Fifty-six women (24.1 ± 3.1 years old) participated of the study. Their average pain was 6.2 points and they presented pain in the abdomen (100%), low back (78.6%), head (55.4%) and lower limbs (50%). All reliability measures were considered excellent (ICC > 0.75) for the total pain area; test–retest SEM and SDC were 5.7% and 15.7%, respectively. Inter-rater SEM and SDC were 8% and 22.1%, respectively. Correlation between total pain area and pain intensity was moderate in the first (rho = 0.30; p = 0.021) and in the second menstruations (rho = 0.40; p = 0.002). Conclusion Women with PD presented multisite pain, which could be assessed with the pain drawing, considered a reliable measurement.
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Unnisa H, Annam P, Gubba NC, Begum A, Thatikonda K. Assessment of quality of life and effect of non-pharmacological management in dysmenorrhea. Ann Med Surg (Lond) 2022; 81:104407. [PMID: 36147090 PMCID: PMC9486665 DOI: 10.1016/j.amsu.2022.104407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022] Open
Abstract
Background Materials & methods Results Conclusion This study outlines the effect of dysmenorrhea by assessing factors contributing to discomfort and pain during menstruation. It also adds to the literature by proving that dysmenorrhea affects the quality of life. It indicates that non-pharmacological measures are both safe and effective in treating dysmenorrhea. It reflects the need for more research and the application of alternate approaches for alleviating menstrual pain. This research also aided in educating young generations on the myths and truths surrounding menstruation and its management.
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14
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de Arruda GT, Driusso P, Rodrigues JC, de Godoy AG, Avila MA. Numerical rating scale for dysmenorrhea-related pain: a clinimetric study. Gynecol Endocrinol 2022; 38:661-665. [PMID: 35850576 DOI: 10.1080/09513590.2022.2099831] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective: To evaluate the numerical rating scale (NRS) measurement properties in women with dysmenorrhea. Methods: This was an online clinimetric study. Brazilian women aged over 18 years old with internet access to respond to online instruments were included in the study. We evaluated criterion validity (comparing women with and without dysmenorrhea), construct validity between the NRS and the bodily pain domain of the SF-36, test-retest reliability, and measurement errors (in women with dysmenorrhea). Results: Two hundred thirty-eight women with and 192 without dysmenorrhea participated in the study. For criterion validity, the area under the receiver operating characteristic curve was 0.902 (95%CI, 0.873-0.931), and a cutoff point of 3 was considered to have the best sensitivity (83%) and specificity (86%). For construct validity, the NRS showed a moderate negative correlation with the SF-36 bodily pain domain (r=-0.46; p < 0.001). For test-retest reliability and measurement errors, 105 women whose symptoms did not change between 7 and 10 days of retest, with intraclass correlation coefficient = 0.90, standard error of measurement = 0.97, and smallest detectable change = 2.76 points. Conclusions: The NRS can be considered a valid and reliable patient-reported outcome measure for assessing dysmenorrhea-related pain intensity.
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Affiliation(s)
- Guilherme Tavares de Arruda
- Study Group on Chronic Pain (NEDoC), Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, São Carlos, Brazil
| | - Patricia Driusso
- Study Group on Chronic Pain (NEDoC), Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, São Carlos, Brazil
| | - Jéssica Cordeiro Rodrigues
- Laboratory of Research on Women's Health (LAMU), Physical Therapy Post-graduate Program and Physical Therapy Department, UFSCar, São Carlos, SP, Brazil
| | - Amanda Garcia de Godoy
- Study Group on Chronic Pain (NEDoC), Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, São Carlos, Brazil
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, São Carlos, Brazil
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15
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Pavlović JM, Derby CA. Pain in midlife women: a growing problem in need of further research. Womens Midlife Health 2022; 8:4. [PMID: 35509086 PMCID: PMC9068256 DOI: 10.1186/s40695-022-00074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
More than 10% of American adults experience some level of daily pain, and nearly 40 million (17.6%) experience episodes of severe pain annually. Women are particularly impacted by both episodic and chronic pain with higher prevalence and a greater level of pain-related disability compared to men. Midlife is a critical period for women during which the frequency of pain complaints begins to increase. Although pain is known to be influenced and controlled by sex hormones, it has not been widely recognized as a symptom of the menopausal transition outside of the menopause research community. The recent thematic series in this journal has specifically highlighted pain related conditions including rheumatoid arthritis, migraine and abdominal pain for which the significance among midlife women is not typically recognized. The studies presented in this thematic series present a small fraction of relevant, understudied questions regarding pain and its impact on women in midlife. Addressing the gaps in knowledge will require longitudinal studies that consider the emergence of pain symptomatology in relation to midlife trajectories of other symptoms and health determinants, as well as further study of new and emerging therapies.
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Affiliation(s)
- Jelena M Pavlović
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. .,Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA.
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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16
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Ullah A, Fayyaz K, Javed U, Usman M, Malik R, Arif N, Kaleem A. Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women. PAIN MEDICINE 2021; 22:2851-2862. [PMID: 34505897 DOI: 10.1093/pm/pnab273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The study was conducted to determine the prevalence of dysmenorrhea and investigate factors associated with dysmenorrhic pain among university students in Lahore, Pakistan. DESIGN AND SETTING A cross-sectional study was conducted across various public and private sector universities in Lahore. METHODS A self-administered structured questionnaire was used to collect data from 600 randomly selected female university students. RESULTS The prevalence of dysmenorrhea was 91.5%. Age at menarche (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.10-3.50) was the only significant factor associated with dysmenorrhea. The mean pain severity score among dysmenorrhic students was 5.62 ± 2.28. Most of the participants (65.8%) were experiencing moderate/severe pain. Univariate analysis showed that irregular cycle (OR [95% CI] = 1.62 [1.13-2.33]), age at menarche of ≤14 years (OR [95% CI] = 1.46 [1.05-2.04]), duration of menses of more than 5 days (OR [95% CI] = 1.42 [1.02-1.99]), stress (OR [95% CI] = 2.16 [1.54-3.03]), moderate meat/protein consumption (OR [95% CI] = 1.55 [1.08-2.21]), and medical specialization (OR [95% CI] = 1.72 [1.17-2.52]) were significantly associated with pain severity among dysmenorrhic female students. Multivariate binary logistic regression analysis revealed that medical specialization (OR [95% CI] = 1.83 [1.22-2.73]), age at menarche (OR [95% CI] = 0.603 [0.42-0.86]), regularity of menses (OR [95% CI] = 1.52 [1.04-2.22]), moderate meat/protein consumption (OR [95% CI] = 1.69 [1.16-2.45]), and stress (OR [95% CI] = 1.87 [1.32-2.66]) were independent predictors of moderate/severe dysmenorrhic pain. CONCLUSION The study revealed an alarmingly high prevalence of dysmenorrhea among university students. High levels of stress and early menarche were the potent determinants of moderate/severe dysmenorrhea that disturbs quality of life.
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Affiliation(s)
- Azmat Ullah
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Khadijah Fayyaz
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Uswa Javed
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Usman
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Rameesha Malik
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Nafeesa Arif
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amna Kaleem
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
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17
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Durand H, Monahan K, McGuire BE. Prevalence and Impact of Dysmenorrhea Among University Students in Ireland. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2835-2845. [PMID: 33822197 PMCID: PMC8666000 DOI: 10.1093/pm/pnab122] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Primary dysmenorrhea (PD), or painful menstruation, is a common gynecological condition that can cause intense pain and functional disability in women of reproductive age. As a nonmalignant condition, PD is relatively understudied and poorly managed. The purpose of this study was to estimate the prevalence and impact of PD among third-level students in Ireland. DESIGN A cross-sectional observational design was used. METHODS Students (n = 892; age range = 18-45 years) completed an online survey on menstrual pain characteristics, pain management strategies, pain interference, and pain catastrophizing. RESULTS The prevalence of PD was 91.5% (95% confidence interval = 89.67-93.33). Nonpharmacological management strategies were most popular (95.1%); of these, heat application (79%), rest (60.4%), hot shower/bath (40.9%), and exercise (25.7%) were most common. Perceived effectiveness of these methods varied between participants. Analgesic use was also common (79.5%); of these, paracetamol was most used (60.5%) despite limited perceived effectiveness. Pain catastrophizing was a significant predictor of variance in both pain intensity and pain interference scores such that those with higher pain catastrophizing scores reported more intense pain and greater interference with daily activities and academic demands. CONCLUSIONS This article presents the first investigation into PD among third-level students in Ireland. Poorly managed menstrual pain may impact functional ability across several domains. Future research should focus on improving menstrual pain management education and support and promoting menstrual health literacy for women affected by PD.
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Affiliation(s)
- Hannah Durand
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Katie Monahan
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
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18
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Chen CX, Carpenter JS, LaPradd M, Ofner S, Fortenberry JD. Perceived Ineffectiveness of Pharmacological Treatments for Dysmenorrhea. J Womens Health (Larchmt) 2021; 30:1334-1343. [PMID: 33026968 PMCID: PMC8558084 DOI: 10.1089/jwh.2020.8581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Dysmenorrhea affects most reproductive-aged women. Common dysmenorrhea treatments vary in their effectiveness across individuals. Little is known about factors associated with perceived treatment ineffectiveness. The objectives of this study were to describe the perceived ineffectiveness of common pharmacological treatments for dysmenorrhea and investigate factors associated with perceived treatment ineffectiveness. Materials and Methods: In this cross-sectional study, 678 women with dysmenorrhea (aged 14-42) provided data on perceived treatment ineffectiveness, dysmenorrhea symptom-based phenotypes, demographics, clinical factors, and psychobehavioral characteristics. We used Fisher's exact tests to compare treatment ineffectiveness across three symptom-based phenotypes. We used logistic regressions to explore associations of phenotype, demographic, clinical, and psychobehavioral correlates of perceived treatment ineffectiveness. Results: Percentages perceiving treatments as ineffective were 29.3%-35.6% nonsteroidal anti-inflammatory drugs, 49.9% acetaminophen, and 39.3% combined oral contraceptive pills (OCPs). Factors associated with perceived ineffectiveness varied across treatments and included symptom-based phenotypes, clinical, and psychobehavioral factors. For ibuprofen and acetaminophen, women with severe (vs. mild) pain phenotype and higher number of chronic pain conditions were more likely to perceive the treatments as ineffective. For OCPs, women with severe pain (vs. mild) phenotype, comorbid gynecological condition, less anxiety, and worse depressive symptoms were more likely to perceive the treatment as ineffective. Conclusion: A significant percentage of women reported ineffectiveness of dysmenorrhea treatments. Phenotypes, clinical, and psychobehavioral factors were associated with treatment ineffectiveness. Future research should test if symptom-based phenotypes are associated with treatment effectiveness in clinical trials and investigate other factors that affect dysmenorrhea treatment effectiveness, so treatments can be tailored to individuals.
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Affiliation(s)
- Chen X. Chen
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Janet S. Carpenter
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Evans S, Villegas V, Dowding C, Druitt M, O'Hara R, Mikocka-Walus A. Treatment use and satisfaction in Australian women with endometriosis: A mixed-methods study. Intern Med J 2021; 52:2096-2106. [PMID: 34396651 DOI: 10.1111/imj.15494] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
AIMS This study aimed to document the frequency of conventional and complementary treatments used by Australian women with endometriosis and the perceived efficacy of these treatments; and to qualitatively explore women's treatment satisfaction. METHODS Using a mixed-methods design, 532 women with self-reported endometriosis were recruited from the community. METHOD Participants were asked about their medication, complementary and self-care treatment use, as well as perceived efficacy on a 0 (not effective) - 10 (extremely effective) numeric rating scale (NRS), and open-ended qualitative survey items about treatment satisfaction. RESULTS 97% of women used medication for pain relief (mean perceived efficacy = 5.05) and 89% used complementary/ self-care strategies (mean perceived efficacy = 3.70), with medication rated as significantly more effective (p <.001). Content analysis of the qualitative data identified that 36% of women were dissatisfied with treatment, 34% were somewhat satisfied, and 24% were satisfied. We identified qualitative themes relating to: 1) Barriers to treatment, which included lack of access, stigma, and disappointment with medical professionals who were perceived as uncaring, unhelpful and in some cases, psychologically damaging; 2) The need for holistic, interdisciplinary care; and 3) Patient knowledge, advocacy and resilience in endometriosis management. CONCLUSIONS Our findings reveal important limitations in the current Australian healthcare model, including the need for patient-centred interdisciplinary care that treats the biopsychosocial needs of people with endometriosis; and widespread pain education, spanning medical training to community awareness. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Subhadra Evans
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - Valeria Villegas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - Charlotte Dowding
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - Marilla Druitt
- University Hospital, Geelong, Australia.,Deakin University, Geelong, Australia
| | - Rebecca O'Hara
- Robinson Research Institute, University of Adelaide, South Australia, Australia
| | - Antonina Mikocka-Walus
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
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20
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Evans S, Dowding C, Druitt M, Mikocka-Walus A. "I'm in iso all the time anyway": A mixed methods study on the impact of COVID-19 on women with endometriosis. J Psychosom Res 2021; 146:110508. [PMID: 33993063 PMCID: PMC8101001 DOI: 10.1016/j.jpsychores.2021.110508] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has resulted in restrictions and social isolation measures, which carry mental health risks. Cancellation of surgery and appointments, medication shortages and fear of the virus itself may have further challenged wellbeing. We aimed to understand how COVID-19 has affected people with endometriosis. METHODS Using a mixed methods design, we examined; 1) the impact of COVID-19 on endometriosis related healthcare, symptoms and functioning; and 2) the relationship between a measure of fear of COVID-19 and qualitative impact in 162 women with endometriosis. RESULTS We found that 60% of women reported impact of the pandemic upon healthcare, with sub-themes documenting the difficulty of cancelled and delayed treatment, specific COVID-19 barriers, and the advantages and disadvantages of telehealth. Only 23% reported negative impact on symptoms, specifically stress; 76% reported impact on daily functioning, with sub-themes related to compromised work, social life and healthy living. A 'hidden benefits' theme revealed ways that COVID-19 had improved some women's lives, including working from home, and the opportunity for healthy lifestyle choices. Logistic regressions revealed that fear of COVID-19 significantly predicted impact themes (healthcare odds ratio = 0.93, 95% confidence interval: 0.87-0.98; symptoms odds ratio = 0.88, 95% confidence interval: 0.82-0.95; functioning odds ratio = 0.92, 95% confidence interval: 0.85-0.99). CONCLUSION Our findings indicate the need to provide patients with supportive care during pandemic restrictions that leverage self-management strategies.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia; Faculty of Health, The Centre for Social and Early Emotional Development, Australia.
| | | | - Marilla Druitt
- School of Psychology, Deakin University, Geelong, Australia,University Hospital Geelong, Australia
| | - Antonina Mikocka-Walus
- School of Psychology, Deakin University, Geelong, Australia,Faculty of Health, The Centre for Social and Early Emotional Development, Australia
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21
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The effect of turmeric on primary dysmenorrhea: Prospective case-control study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.828571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Chen CX, Carpenter JS, Gao X, Toh E, Dong Q, Nelson DE, Mitchell C, Fortenberry JD. Associations Between Dysmenorrhea Symptom-Based Phenotypes and Vaginal Microbiome: A Pilot Study. Nurs Res 2021; 70:248-255. [PMID: 33813547 PMCID: PMC8222084 DOI: 10.1097/nnr.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Dysmenorrhea is highly prevalent; it places women at risk for other chronic pain conditions. There is a high degree of individual variability in menstrual pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Distinct dysmenorrhea symptom-based phenotypes were previously identified, but the biological underpinnings of these phenotypes are less known. One underexplored contributor is the vaginal microbiome. The vaginal microbiota differs significantly among reproductive-age women and may modulate as well as amplify reproductive tract inflammation, which may contribute to dysmenorrhea symptoms. OBJECTIVES The objective of this study was to examine associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome compositions on- and off-menses. METHODS We conducted a prospective, longitudinal, pilot study of 20 women (aged 15-24 years) grouped into three dysmenorrhea symptom-based phenotypes: "mild localized pain," "severe localized pain," and "severe multiple pain and gastrointestinal symptoms." Over one menstrual cycle, participants provided vaginal swabs when they were on- and off-menses. We assayed the vaginal microbiome using 16S rRNA gene sequencing. Permutational multivariate analysis of variance tests were used to compare microbiome compositions across phenotypes, with heat maps generated to visualize the relative abundance of bacterial taxa. RESULTS The vaginal microbiome compositions (n = 40) were different across the three phenotypes. After separating the on-menses (n = 20) and off-menses (n = 20) specimens, the statistically significant difference was seen on-menses, but not off-menses. Compared to the "mild localized pain" phenotype, participants in the "multiple severe symptoms" phenotype had a lower lactobacilli level and a higher abundance of Prevotella, Atopobium, and Gardnerella when on-menses. We also observed trends of differences across phenotypes in vaginal microbiome change from off- to on-menses. DISCUSSION The study provides proof-of-concept data to support larger studies on associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome that might lead to new intervention targets and/or biomarkers for dysmenorrhea. This line of research has the potential to inform precision dysmenorrhea treatment that can improve women's quality of life.
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Affiliation(s)
- Chen X. Chen
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Xiang Gao
- Loyola University Chicago, Stritch School of Medicine, Department of Medicine, Maywood, IL
| | - Evelyn Toh
- Indiana University School of Medicine, Department of Microbiology and Immunology, Indianapolis, IN, USA
| | - Qunfeng Dong
- Loyola University Chicago, Stritch School of Medicine, Department of Medicine, Maywood, IL
| | - David E. Nelson
- Indiana University School of Medicine, Department of Microbiology and Immunology, Indianapolis, IN, USA
| | - Caroline Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
- Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - J. Dennis Fortenberry
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, IN, USA
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Evans S, Dowding C, Olive L, Payne LA, Druitt M, Seidman LC, Skvarc D, Mikocka-Walus A. Pain catastrophizing, but not mental health or social support, is associated with menstrual pain severity in women with dysmenorrhea: A cross-sectional survey. PSYCHOL HEALTH MED 2021; 27:1410-1420. [PMID: 34190659 DOI: 10.1080/13548506.2021.1948581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to understand the relationship between psychosocial factors, including mental health, pain cognitions and social support associated with menstrual pain severity in women with dysmenorrhea of no identified medical cause (primary dysmenorrhea; PD) and dysmenorrhea related to endometriosis. Participants included 1192 women aged 18-50 years with menstrual pain, recruited to an online cross-sectional survey in 2019. Questionnaires assessed self-reported menstrual pain severity, depression, anxiety, stress, pain catastrophizing, and social support. Women with endometriosis had significantly higher menstrual pain severity (p < 0.001) and pain catastrophizing (p < 0.001) than women with PD. Of the psychosocial factors, only pain catastrophizing (specifically, the helplessness sub-scale) predicted menstrual pain severity in each group. Overall, 36% of women with PD and 58% with endometriosis had clinically relevant levels of pain catastrophizing. Findings suggest a common psychological mechanism in women with menstrual pain, regardless of etiology. Interventions to reduce pain helplessness may be beneficial in supporting women with dysmenorrhea.
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Affiliation(s)
- Subhadra Evans
- Center for Social and Early Emotional Development , School of Psychology, Deakin University, Geelong, Australia
| | | | - Lisa Olive
- Center for Social and Early Emotional Development , School of Psychology, Deakin University, Geelong, Australia.,Centre for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, Australia
| | - Laura A Payne
- McLean Hospital/Harvard Medical School, Belmont, Massachusetts, USA
| | - Marilla Druitt
- University Hospital Geelong, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | | | - David Skvarc
- Center for Social and Early Emotional Development , School of Psychology, Deakin University, Geelong, Australia
| | - Antonina Mikocka-Walus
- Center for Social and Early Emotional Development , School of Psychology, Deakin University, Geelong, Australia
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Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The Impact of Menstrual Cycle Phase on Athletes' Performance: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1667. [PMID: 33572406 PMCID: PMC7916245 DOI: 10.3390/ijerph18041667] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women's sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population. Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors. Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective performance outcomes between studies.
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Affiliation(s)
- Mikaeli Anne Carmichael
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.L.T.); (T.P.W.)
| | - Rebecca Louise Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.L.T.); (T.P.W.)
- Adelaide Medical School and Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia;
| | - Lisa Jane Moran
- Adelaide Medical School and Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia;
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC 3168, Australia
| | - Thomas Philip Wycherley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.L.T.); (T.P.W.)
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Evans S, Mikocka-Walus A, Olive L, Seidman LC, Druitt M, Payne LA. Phenotypes of Women with and Without Endometriosis and Relationship with Functional Pain Disability. PAIN MEDICINE 2020; 22:1511-1521. [DOI: 10.1093/pm/pnaa362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objective
Primary dysmenorrhea and secondary dysmenorrhea due to endometriosis share overlapping symptoms and likely demonstrate aspects of central sensitization. The present study aimed to identify distinct phenotypes of women who have dysmenorrhea with and without endometriosis to shed light on the unique mechanisms contributing to the pathogenesis of each condition.
Methods
An online survey was used to investigate the relationship between ratings of menstrual pain severity, menstrual symptoms (abdominal cramps, abdominal discomfort, low back pain, headache, body aches, bloating, nausea, diarrhea, increased bowel movements), widespread pain, and functional pain disability in a community sample of 1,354 women (aged 18–50) with menstrual pain in Australia.
Results
Compared with women without endometriosis, those with endometriosis had statistically significant higher menstrual pain severity (P<0.01), symptom severity and fatigue (all symptoms P<0.001, although only cramps and bloating were clinically significant), widespread pain sites (P<0.001), and functional pain disability (P<0.001, although this difference was not clinically significant). When examining symptoms by pain severity, women with severe menstrual pain were more likely to experience symptoms than women with less severe pain, regardless of the presence of endometriosis. Similar predictors of functional pain disability emerged for women with and without endometriosis, such as body aches, nausea, fatigue, and widespread pain, respectively, suggesting the presence of central sensitization in both groups. Logistic regression revealed that after accounting for menstrual pain severity (odds ratio [OR], 1.61) and duration (OR, 1.04), symptoms of bloating (OR, 1.12), nausea (OR, 1.07), and widespread pain sites (OR, 1.06) significantly predicted the presence of endometriosis.
Conclusions
The findings suggest that phenotypes specific to endometriosis can be identified.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Lisa Olive
- School of Psychology, Deakin University, Geelong, Australia
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Institute, School of Medicine, Deakin University, Geelong, Australia
| | | | | | - Laura A Payne
- McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Fernández-Martínez E, Abreu-Sánchez A, Pérez-Corrales J, Ruiz-Castillo J, Velarde-García JF, Palacios-Ceña D. Living with Pain and Looking for a Safe Environment: A Qualitative Study among Nursing Students with Dysmenorrhea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6670. [PMID: 32933209 PMCID: PMC7558082 DOI: 10.3390/ijerph17186670] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
Dysmenorrhea refers to chronic pain associated with menstruation that is often accompanied by other symptoms. Primary dysmenorrhea (PD) occurs without any associated pelvic disease. Nonetheless, it may negatively affect women's quality of life. Among university students, dysmenorrhea decreases academic performance and is a cause of absenteeism. The purposes of our study were to describe how nursing students experienced PD and the changes affecting their body and mood. A qualitative case study was performed among 33 nursing students with PD. Data were collected through five focus groups (with two sessions each) and 10 researchers' field notes. We used a video meeting platform to conduct the focus groups. A thematic analysis was performed, and the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Three main themes emerged from the data: (a) living with dysmenorrhea, with two subthemes: menstruation and pain; (b) body changes and mood swings; and (c) seeking a safe environment, with three subthemes: safe environment, unsafe environment, and key safety aspects. Students considered menstruation to be negative and limiting, causing physical and mood changes, making them feel less attractive, and conditioning their way of dressing and relating.
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Affiliation(s)
- Elia Fernández-Martínez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
| | - Javier Ruiz-Castillo
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Juan Francisco Velarde-García
- Department of Nursing, Red Cross College, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Autónoma de Madrid, Calle Reina Victoria 28, 28003 Madrid, Spain;
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
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Samadipour E, Rakhshani MH, Kooshki A, Amin B. Local Usage of Nigella sativa Oil as an Innovative Method to Attenuate Primary Dysmenorrhea: A Randomized Double-blind Clinical Trial. Oman Med J 2020; 35:e167. [PMID: 32953142 PMCID: PMC7480012 DOI: 10.5001/omj.2020.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives We sought to determine the effect of topical application of Nigella sativa (black seed) oil, on the primary dysmenorrhea intensity. Methods We conducted a randomized, double-blind clinical trial on 124 female students, 18–22 years old, living in the dormitories of Sabzevar Universities. After a primary assessment, participants were randomly divided into two groups. The first group rubbed two drops of N. sativa oil, and the second group rubbed liquid olive oil, as the placebo. Massage was performed on the fontanel lobe 3, at night, three days before menstruation, for eight consecutive days (about five days after menses). This procedure was repeated for three menstrual cycles. After three cycles, pain severity was measured by the visual analog scale. Data analysis was carried out using the Mann-Whitney U test and analysis of covariance (ANCOVA). Results This study was conducted on 124 female students. The mean age of students, mean age of first menarche, body mass index, and pain severity were not significantly different in the two groups (p > 0.050). No adverse effects were observed during the study. The results of ANCOVA showed that pain intensity in N. sativa oil group was significantly decreased compared to that of the placebo group (0.6 score; p < 0.050). Conclusions N. sativa could be a promising, safe, and easily available analgesic supplement in women suffering from primary dysmenorrhea.
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Affiliation(s)
- Ezat Samadipour
- Department of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Akram Kooshki
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Bahareh Amin
- Cellular and Molecular Research Center, Department of Physiology and Pharmacology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Ferreira LS, de Nadai MN, Poli-Neto OB, Franceschini SA, Juliato CRT, Monteiro IMU, Bahamondes L, Vieira CS. Predictors of severe pain during insertion of the levonorgestrel 52 mg intrauterine system among nulligravid women. Contraception 2020; 102:267-269. [PMID: 32679045 DOI: 10.1016/j.contraception.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify sociodemographic and clinical variables associated with severe pain with levonorgestrel 52 mg intrauterine system (IUS) placement among nulligravid women. STUDY DESIGN We performed a secondary analysis of a randomized trial that evaluated intracervical anesthesia before IUS insertion. We assessed factors associated with severe pain (visual analog scale pain score ≥7) immediately after insertion using bivariate and multiple regression analyses. RESULTS Overall, 137/300 (45.7%) subjects reported severe pain. In multiple regression analysis, only intracervical anesthesia [RR 0.55, 95% CI 0.37-0.80] and a history of dysmenorrhea [RR 1.36, 95% CI 1.08-1.72)] were associated with severe pain. CONCLUSIONS Among nulligravid women, a history of dysmenorrhea increases, and intracervical block decreases severe pain during levonorgestrel IUS insertion. IMPLICATIONS Dysmenorrhea increases the risk of severe pain at levonorgestrel intrauterine system insertion, while receiving an intracervical lidocaine block decreases this risk. This information can be useful for counseling women prior to device placement and for selecting candidates who may particularly benefit from interventions to reduce pain.
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Affiliation(s)
- Letícia Sanchez Ferreira
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - Mariane Nunes de Nadai
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - Omero B Poli-Neto
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - Silvio A Franceschini
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900 Ribeirão Preto, SP, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, Faculty of Medical Science, University of Campinas, Caixa Postal 6181, CEP 13084-971 Campinas, SP, Brazil
| | - Ilza Maria U Monteiro
- Department of Obstetrics and Gynecology, Faculty of Medical Science, University of Campinas, Caixa Postal 6181, CEP 13084-971 Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, Faculty of Medical Science, University of Campinas, Caixa Postal 6181, CEP 13084-971 Campinas, SP, Brazil
| | - Carolina Sales Vieira
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900 Ribeirão Preto, SP, Brazil.
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Chen CX, Murphy T, Ofner S, Yahng L, Krombach P, LaPradd M, Bakoyannis G, Carpenter JS. Development and Testing of the Dysmenorrhea Symptom Interference (DSI) Scale. West J Nurs Res 2020; 43:364-373. [PMID: 32680445 DOI: 10.1177/0193945920942252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysmenorrhea affects most reproductive-age women and increases the risk of future pain. To evaluate dysmenorrhea interventions, validated outcome measures are needed. In this two-phase study, we developed and tested the dysmenorrhea symptom interference scale. During the scale-development phase (n = 30), we created a nine-item scale based on qualitative data from cognitive interviews. During the scale-testing phase (n = 686), we evaluated reliability, validity, and responsiveness to change. The scale measures how dysmenorrhea symptoms interfere with physical, mental, and social activities. Internal consistency was strong with Cronbach's α > 0.9. Test-retest reliability was acceptable (r = 0.8). The scale showed satisfactory content validity, construct validity (supported by confirmatory factor analysis), concurrent validity, and responsiveness to change. The minimally important difference was 0.3 points on a scale with a possible total score ranging from 1 to 5. This new psychometrically sound scale can be used in research and clinical practice to facilitate the measurement and management of dysmenorrhea.
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Affiliation(s)
- Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Tabitha Murphy
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lilian Yahng
- Indiana University Center for Survey Research, Bloomington, IN, USA
| | - Peter Krombach
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Giorgos Bakoyannis
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
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Affiliation(s)
- Michelle M. Gagnon
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Randa Elgendy
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Guimarães I, Póvoa AM. Primary Dysmenorrhea: Assessment and Treatment. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:501-507. [PMID: 32559803 PMCID: PMC10309238 DOI: 10.1055/s-0040-1712131] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of the menstrual cycle. It has major implications for quality of life, such as limitation of daily activities and psychological stress, being one of the main causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.
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Affiliation(s)
- Inês Guimarães
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Margarida Póvoa
- Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Gynecology, Unit of Reproductive Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
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Pegado R, Silva LK, da Silva Dantas H, Andrade Câmara H, Andrade Mescouto K, Silva-Filho EM, Lopes JM, Micussi MTABC, Correia GN. Effects of Transcranial Direct Current Stimulation for Treatment of Primary Dysmenorrhea: Preliminary Results of a Randomized Sham-Controlled Trial. PAIN MEDICINE 2019; 21:3615-3623. [DOI: 10.1093/pm/pnz202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abstract
Objective
The aim of this trial was to investigate the effects of five consecutive sessions of anodal transcranial direct current stimulation (tDCS) over the motor cortex (M1) on pain, mood, and physical performance in patients with primary dysmenorrhea (PDM).
Design
This is a double-blind randomized controlled trial.
Subjects
Twenty-two participants with PDM according to the No. 345-PDM Consensus Guideline were included.
Methods
Eleven active treatment and 11 sham stimulation patients received five applications over a one-week period. The primary outcome measures were pain evaluated by numeric rating scale (NRS) and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule (PANAS), Hamilton Anxiety Scale (HAM-A), grip strength, and six-minute walk test (6MWT). Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected.
Results
The intervention provided significant improvements on NRS in active tDCS, shown as an interaction between group intervention vs pre/postintervention vs days of menstrual cycle (Wald x2 = 10.54, P = 0.005), main effect of days of menstrual cycle (Wald x2 = 25.42, P < 0.001), and pre/postintervention (Wald x2 = 6.97, P = 0.008). McGill showed an interaction effect between pre/postintervention and group of stimulation (Wald x2 = 18.45, P = 0.001), with a large reduction in active tDCS (P < 0.001, d = 0.75). Psychological and functional outcomes did not differ between groups or pre/postintervention.
Conclusions
tDCS could provide pain relief in subjects with PDM. These results provide some preliminary evidence for the potential role of tDCS as a contributor to the management of symptoms of PDM.
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Raisi Dehkordi Z, Rafieian-Kopaei M, Hosseini-Baharanchi FS. A double-blind controlled crossover study to investigate the efficacy of salix extract on primary dysmenorrhea. Complement Ther Med 2019; 44:102-109. [PMID: 31126541 DOI: 10.1016/j.ctim.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Primary dysmenorrhea in the absence of pelvic pathology is a common gynecologic disorder affecting the quality of life of women of reproductive age. This study evaluates the effect of salix extract on primary dysmenorrhea. DESIGN This study was a randomized crossover clinical trial. SETTING The study population included 96 female students with level two or three of primary dysmenorrhea: 48 students in the treatment group (sequence I) followed by control (sequence II) and 48 students in control group (sequence I) followed by treatment (sequence II). INTERVENTIONS The intervention was salix capsule (400 mg daily) and the active control was mefenamic acid capsule (750 mg daily) as. MAIN OUTCOMES Pain intensity, measured by the visual analog scale (VAS), amount of bleeding, and severity of dysmenorrhea symptoms were outcomes. Generalized estimating equations were used for data analysis. RESULTS The demographic and menstrual characteristics of the students were homogenous between the groups. The results showed that the students in mefenamic acid group had a significantly higher level of VAS than the students in the salix group over time (1.61 ± 0.06, P < 0.001). The estimated odds of the bleeding level in the salix and mefenamic acid group were not significantly different (P = 0.31). In average, 77.39%±16.18 of the students in salix group showed no symptoms followed by 22.18%±14.08 of the students who experienced mild symptoms. Averagely, 44.58%±20.16 of the students in the mefenamic acid group had mild symptoms followed by moderate symptoms (28.12%±15.29). CONCLUSIONS Salix extract significantly decreased dysmenorrhea in comparison to mefenamic acid, as the standard treatment of dysmenorrhea.
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Affiliation(s)
- Z Raisi Dehkordi
- Department of Midwifery, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - M Rafieian-Kopaei
- Medical Plants Research Center, Shahrekord University of Medical Science, Shahrekord, Iran.
| | - F S Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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Chen CX, Draucker CB, Carpenter JS. What women say about their dysmenorrhea: a qualitative thematic analysis. BMC Womens Health 2018; 18:47. [PMID: 29499683 PMCID: PMC5833075 DOI: 10.1186/s12905-018-0538-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/21/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dysmenorrhea is highly prevalent and is the leading cause of absence from school and work among women of reproductive age. Evidence suggests that dysmenorrhea may also be a risk factor for other chronic pain conditions. Limited research has examined women's experience with dysmenorrhea using qualitative data. Research is warranted to address issues and needs that are important from women's own perspectives. Therefore, the purpose of this study was to describe women's salient thoughts about their experiences of dysmenorrhea. METHODS We analyzed data collected from an open-ended question within a cross-sectional survey study conducted in the United States. Using qualitative thematic analysis, free text responses to a question asking women to share their experience with dysmenorrhea were analyzed. RESULTS The sample consisted of 225 women who provided valid responses to the open-ended question. Six themes were identified: (1) The dysmenorrhea symptom experience varied among women; (2) The dysmenorrhea symptom experience varied across time, (3) A variety of factors influenced the dysmenorrhea symptom experience, (4) Dysmenorrhea symptoms could have a negative impact on the women's daily lives, (5) Dysmenorrhea was not seen as a legitimate health issue by the women, health care providers, or society, and (6) Treatment for women with dysmenorrhea varied in acceptability and effectiveness. CONCLUSIONS The findings of this study have important implications for dysmenorrhea symptom assessment and the development of personalized interventions to support dysmenorrhea management.
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Affiliation(s)
- Chen X. Chen
- Indiana University School of Nursing, 600 Barnhill Drive, NU E415, Indianapolis, IN 46202 USA
| | - Claire B. Draucker
- Indiana University School of Nursing, 600 Barnhill Drive, NU E415, Indianapolis, IN 46202 USA
| | - Janet S. Carpenter
- Indiana University School of Nursing, 600 Barnhill Drive, NU E415, Indianapolis, IN 46202 USA
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Teherán AA, Piñeros LG, Pulido F, Mejía Guatibonza MC. WaLIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. Int J Womens Health 2018; 10:35-45. [PMID: 29398923 PMCID: PMC5775738 DOI: 10.2147/ijwh.s143510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Dysmenorrhea is a frequent and misdiagnosed symptom affecting the quality of life in young women. A working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) score was designed to diagnose dysmenorrhea and to predict medical leave. Methods This cross-sectional design included young medical students, who completed a self-administered questionnaire that contained the verbal rating score (VRS; pain and drug subscales) and WaLIDD scales. The correlation between scales was established through Spearman test. The area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio (LR +/-) were evaluated to diagnose students availing medical leave due to dysmenorrhea; moreover, to predict medical leave in students with dysmenorrhea, a binary logistic regression was performed. Results In all, 585 students, with a mean age of 21 years and menarche at 12 years, participated. Most of them had regular cycles, 5 days of menstrual blood flow and 1-2 days of lower abdominal pain. The WaLIDD scale presented an adequate internal consistency and strong correlation with VRS subscales. With a cutoff of >6 for WaLIDD and 2 for VRS subscales (drug subscale and pain subscale) to identify students with dysmenorrhea, these scales presented an area under the curve (AUC) ROC of 0.82, 0.62, and 0.67, respectively. To identify students taking medical leave due to dysmenorrhea, WaLIDD (cutoff >9) and VRS subscales (cutoff >2) presented an AUC ROC of 0.97, 0.68, and 0.81; moreover, the WaLIDD scale showed a good LR +14.2 (95% CI, 13.5-14.9), LR -0.00 (95% CI, undefined), and predictive risk (OR 5.38; 95% CI, 1.78-16.2). Conclusion This research allowed a comparison between two multidimensional scales regarding their capabilities, one previously validated and a new one, to discriminate among the general population of medical students, among those with dysmenorrhea or those availing medical leave secondary to dysmenorrhea. WaLIDD score showed a larger effect size than the pain and drug score in the students. In addition, this study demonstrated the ability to predict this combination of events.
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Affiliation(s)
| | | | - Fabián Pulido
- University Hospital San José of Bogotá, Bogotá, Colombia
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Feng X, Wang X. Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs for patients with primary dysmenorrhea: A network meta-analysis. Mol Pain 2018; 14:1744806918770320. [PMID: 29587566 PMCID: PMC5987898 DOI: 10.1177/1744806918770320] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Non-steroidal anti-inflammatory drugs are used as first-line treatment of primary dysmenorrhea, but there has been no optimal clinical choice among non-steroidal anti-inflammatory drugs yet. The present study was to assess the relative benefits of different common non-steroidal anti-inflammatory drugs for primary dysmenorrhea patients with a network meta-analysis. Methods Randomized controlled trials were screened by our criteria and included in the network meta-analysis. Pain relief was considered as primary outcomes and adverse effect was supplied as a safety outcome, while additional rescue, assessment score, and pain intensity difference were secondary outcomes. All the indexes were evaluated with odds ratio or standardized mean difference. Surface under cumulative ranking curve result was used to calculate the ranking of each treatment. Results Totally, 72 randomized controlled trials of 5723 patients and 13 drugs were included in our study after screening. As for pain relief, all drugs except nimesulide, rofecoxib, and waldecoxib were superior to aspirin (odds ratio with 95% credible intervals, diclofenac: 0.28 (0.08, 0.86), flurbiprofen: 0.10 (0.03, 0.29), ibuprofen: 0.32 (0.14, 0.73), indomethacin: 0.21 (0.07, 0.58), ketoprofen: 0.25 (0.10, 0.64), mefenamic acid: 0.28 (0.09, 0.87), naproxen: 0.31 (0.15, 0.64), piroxicam: 0.15 (0.03, 0.59), and tiaprofenic acid: 0.17 (0.04, 0.63)). Aspirin also required additional rescue when compared with the majority of other drugs (flurbiprofen: 3.46 (1.15, 11.25), ibuprofen: 6.30 (2.08, 20.09), mefenamic acid: 7.32 (1.51, 37.71), naproxen: 2.66 (1.17, 6.55), and tiaprofenic acid: 9.58 (1.43, 94.63)). As for assessment of the whole treatment, ketoprofen, naproxen, rofecoxib, and ibuprofen got higher score significantly than placebo. In addition, ibuprofen performed better than placebo in pain intensity difference. Considering the safety, tiaprofenic acid and mefenamic acid were noticeable in low risk, and indomethacin revealed higher risk than any other drugs. According to the results of network analysis and surface under cumulative ranking curve, flurbiprofen was considered to be the best one among all the treatments in efficacy, and aspirin was worse than most of others. On the other hand, tiaprofenic acid and mefenamic acid were indicated as the safest drugs. Conclusion Considering the efficacy and safety, we recommended flurbiprofen and tiaprofenic acid as the optimal treatments for primary dysmenorrhea.
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Affiliation(s)
- Xuan Feng
- Department of Gynecology, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Postdoctoral Research Station, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyun Wang
- Department of Gynecology, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
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Genome-wide association analysis of pain severity in dysmenorrhea identifies association at chromosome 1p13.2, near the nerve growth factor locus. Pain 2017; 157:2571-2581. [PMID: 27454463 PMCID: PMC5436737 DOI: 10.1097/j.pain.0000000000000678] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Genome-wide association study on 11,891 females of European descent for self-reported dysmenorrhea pain severity identified a significant association that colocalises with the NGF locus. Dysmenorrhea is a common chronic pelvic pain syndrome affecting women of childbearing potential. Family studies suggest that genetic background influences the severity of dysmenorrhea, but genetic predisposition and molecular mechanisms underlying dysmenorrhea are not understood. In this study, we conduct the first genome-wide association study to identify genetic factors associated with dysmenorrhea pain severity. A cohort of females of European descent (n = 11,891) aged 18 to 45 years rated their average dysmenorrhea pain severity. We used a linear regression model adjusting for age and body mass index, identifying one genome-wide significant (P < 5 × 10−8) association (rs7523086, P = 4.1 × 10−14, effect size 0.1 [95% confidence interval, 0.074–0.126]). This single nucleotide polymorphism is colocalising with NGF, encoding nerve growth factor. The presence of one risk allele corresponds to a predicted 0.1-point increase in pain intensity on a 4-point ordinal pain scale. The putative effects on NGF function and/or expression remain unknown. However, genetic variation colocalises with active epigenetic marks in fat and ovary tissues, and expression levels in aorta tissue of a noncoding RNA flanking NGF correlate. Participants reporting extreme dysmenorrhea pain were more likely to report being positive for endometriosis, polycystic ovarian syndrome, depression, and other psychiatric disorders. Our results indicate that dysmenorrhea pain severity is partly genetically determined. NGF already has an established role in chronic pain disorders, and our findings suggest that NGF may be an important mediator for gynaecological/pelvic pain in the viscera.
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Chen CX, Ofner S, Bakoyannis G, Kwekkeboom KL, Carpenter JS. Symptoms-Based Phenotypes Among Women With Dysmenorrhea: A Latent Class Analysis. West J Nurs Res 2017; 40:1452-1468. [PMID: 28914180 DOI: 10.1177/0193945917731778] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dysmenorrhea is highly prevalent and may increase women's risk for developing other chronic pain conditions. Although it is highly variable, symptom-based dysmenorrhea phenotypes have not been identified. The aims of the study were to identify symptom-based dysmenorrhea phenotypes and examine their relationships with demographic and clinical characteristics. In a cross-sectional study, 762 women with dysmenorrhea rated severity of 14 dysmenorrhea-related symptoms. Using latent class analysis, we identified three distinctive phenotypes. Women in the "mild localized pain" phenotype ( n = 202, 26.51%) had mild abdominal cramps and dull abdominal pain/discomfort. Women in the "severe localized pain" phenotype ( n = 412, 54.07%) had severe abdominal cramps. Women in the "multiple severe symptoms" phenotype ( n = 148, 19.42%) had severe pain at multiple locations and multiple gastrointestinal symptoms. Race, ethnicity, age, and comorbid chronic pain conditions were significantly associated with phenotypes. Identification of these symptom-based phenotypes provides a foundation for research examining genotype-phenotype associations, etiologic mechanisms, and/or variability in treatment responses.
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