Title: ‘PAINTING MY PAIN’ – THE USE OF PAIN DRAWINGS TO ASSESS MULTISITE
PAIN IN WOMEN WITH PRIMARY DYSMENORRHEA
Version: 1 Date: 30 Mar 2022
Reviewer:  Elia Fernández-martínez
Reviewer's report:
The researchers present an interesting manuscript that includes a novel technique to assess
dysmenorrhoeic pain in women with dysmenorrhoeic pain, such as multisite pain. It is interesting
that new research techniques are being applied to this ailment that was little studied until a
decade ago and even more so because of the difficulties in quantifying/evaluating this pain that
is often normalised by society.
I consider the manuscript to be interesting and suitable for publication in this journal, due to its
methodological quality and the novel aspects it includes, which will be of interest to the reader.
Nevertheless, I make some suggestions for minor changes before publication:
It would be interesting to define in method the study population, its characteristics and inclusion
and exclusion criteria.
The main limitation of the study is the small sample size. It is a pity that out of 215 women who
were invited to participate, only fifty-six  women finally made up the sample.I would like the
researchers to elaborate on possible reasons for the small sample size and to include a section
on the limitations of the study reflecting at least this limitation.
It would be interesting if they could clarify why they established this criterion for their study,
"The period for filling out the NRS was at least 24 hours and at most 72 hours after the first day
of menstruation. " Were they based on previous studies, and which ones?
In the current version of the manuscript, it is not clear to the reader whether the drawing reflected
women's usual menstrual pain or only that of the month prior to the drawing or of a particular
previous period. This is a key issue, as the pain may be variable over time. It would be interesting
to explain this. In addition, the authors do not explain in detail how the drawing procedure was
guided, where?who guided it?how?
"To complete the NRS, the study participants were instructed to define a single number that
would better define their menstrual pain for that menstrual cycle. "This sentence is not clear and
it is essential to explain it clearly. Do you mean your last menstrual period?
"This leads to a better clinical assessment of those patients, and to more thorough, patient-
tailored intervention protocol."This sentence should be revised, as it is too ambitious as it already
refers to a protocol. Due to the sample size involved, it would be interesting to recommend
further use and evaluation of the technique.
Revise table 1, the percentage symbols are missing in the regions.
Finally, I suggest that you read the following recent manuscripts, which you may not have read
previously, and include them in your citation if they are of interest to your manuscript. I think
it would be interesting to give more emphasis in your discussion to the relevance of relevant
assessment of dysmenorrhoea because of its impact on the lives of sufferers as evidenced in
these recently published articles.
-Absenteeism during Menstruation among Nursing Students in Spain.
Fernández-Martínez E, Onieva-Zafra MD, Abreu-Sánchez A, Fernández-Muñóz JJ, Parra-
Fernández ML.
Int J Environ Res Public Health. 2019 Dec 19;17(1):53. doi: 10.3390/ijerph17010053.
-Interference and Impact of Dysmenorrhea on the Life of Spanish Nursing Students.
Abreu-Sánchez A, Ruiz-Castillo J, Onieva-Zafra MD, Parra-Fernández ML, Fernández-
Martínez E.
Int J Environ Res Public Health. 2020 Sep 5;17(18):6473. doi: 10.3390/ijerph17186473.
-Living with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea.
Fernández-Martínez E, Abreu-Sánchez A, Velarde-García JF, Iglesias-López MT, Pérez-
Corrales J, Palacios-Ceña D.
Int J Environ Res Public Health. 2020 Nov 17;17(22):8527. doi: 10.3390/ijerph17228527.