The Effect of Connective Tissue Massage in Women With Primary Dysmenorrhoea
Condition: Dysmenorrhea; Pelvic Pain
MeSH terms: Pelvic Pain; Dysmenorrhea
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effect of connective tissue manipulation on pain
      threshold in women with primary dysmenorrhoea. According to literature, there are studies
      that measure the pain threshold. But there is no randomized controlled trial which explore
      the short and long-term effects of connective tissue manipulation on primary dysmenorrhoea.
      Hypothesis of this study is that connective tissue manipulation increases pain threshold and
      decreases severity of pain in women suffer with primary dysmenorrhoea.
    

Detailed description: 
      Dysmenorrhoea has been defined painful menstruation. It is divided primary and secondary
      dysmenorrhoea according to the pathophysiology. Primary dysmenorrhoea is severe menstrual
      pain, occurs a short time after menarche and without pelvic pathology. Secondary
      dysmenorrhoea is severe menstrual pain that occurs related to pelvic pathology. In primary
      dysmenorrhoea, pain usually begins with menstruation and ends in 48-72 hours. Pain is usually
      felt in the lower abdomen and lumbosacral region. Fatigue, headache, vomiting, diarrhea and
      constipation may be accompanied by primary dysmenorrhoea.

      It is difficult to determine the incidence and etiology of dysmenorrhoea because of the
      variety of the criteria used in the diagnosis of the dysmenorrhoea and subjective symptoms.
      But current studies show that primary dysmenorrhoea is common gynecological problem that
      affects majority of women. Tu et al. indicated that prevalence of primary dysmenorrhoea was
      between 20-90% percent and 15% of cases had severe symptoms.

      Although the etiology of primary dysmenorrhoea is not fully understood, excessive
      prostaglandin production is believed to cause abnormal uterine activity. Hyperalgesia is
      present especially in the deep tissue during the menstrual cycle.

      Various approaches have been proposed until now for the treatment of patients with
      dysmenorrhoea. These are medical treatments (for example paracetamol, NSAID, oral
      contraceptives), alternative treatments (for example herbal products and nutritional
      supplements, dietary changes), surgical treatments and physiotherapy and rehabilitation
      approaches. Connective tissue manipulation (CTM), physiotherapy and rehabilitation approach,
      has been found by German physiotherapist Elizabeth Dicke in 1929. CTM is a manual reflex
      therapy, which produces autonomic responses via cutaneous-visceral reflexes. This safe and
      effective technique consists short and long tractions, which performed on the patients' skin
      by the skilled and experienced physiotherapist. Although the effect mechanism of CTM has not
      been fully understood yet, it is known that the treatment method stimulates autonomic nervous
      system to rebalance the parasympathetic and sympathetic functions. CTM produces autonomic
      stimulus when the stroke is performed on the skin and blood vessels are stimulated by
      autonomic nerve endings located in the tissue interfaces. It has also found that stimulation
      of autonomic nerve endings may results in reduction of sympathetic vasoconstrictor tone leads
      to vasodilatation. Stimulation of skin with strokes affects segmental reflexes. It is known
      that stimulation of segmental reflexes can be used in treatment of organ dysfunctions. CTM
      applied to affected dermatome generates reflex effects in the associated organs, provides
      healing by increasing circulation and decreasing pain. Skin alterations and subcutaneous
      tissue tension are observed in the dermatomes and myotomes, which are innervated by same
      spinal cord level with malfunctioning organ. In addition to these effects, powerful
      stimulation of cutaneous mechanoreceptor induces gate control mechanism, increases pain
      threshold and decreases stress hormones and muscle tension.

      The aim of this study is to investigate the effect of connective tissue manipulation on pain
      threshold in women with primary dysmenorrhoea. According to literature, there are studies
      that measure the pain threshold. But there is no randomized controlled trial which explore
      the short and long-term effects of connective tissue manipulation on primary dysmenorrhoea.
      Hypothesis of this study is that connective tissue manipulation increases pain threshold and
      decreases severity of pain in women suffer with primary dysmenorrhoea.
    

Intervention name(s): lifestyle advice; connective tissue manipulation
Intervention type(s): Other; Other
Intervention description(s): Investigators will give lifestyle advice to patients such as exercising regularly, limiting caffeine, sugar and alcohol intake, reduction or cessation of smoking; Investigators will apply connective tissue manipulation on lumbosacral, lower thoracic, and anterior pelvic regions starting from the estimated time of ovulation until the next period begins
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Dysmenorrhea; Primary dysmenorrhea; physiotherapy; massage; connective tissue massage; connective tissue manipulation