Manual Therapy in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Abstract

Objective

This research aimed to assess the effectiveness of manual therapy in alleviating pain among women undergoing primary dysmenorrhea (PD).

Methods

All randomized controlled trials (RCTs) regarding manual therapy for PD were searched from online databases, spanning from their inception to July 2023. The identified literature underwent a thorough screening process, and the data were meticulously extracted and analyzed using RevMan 5.3. Subsequently, the included studies underwent Cochrane’s quality assessment and meta-analysis. The evidence obtained was then assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.

Results

32 RCTs, involving 2566 women were finally included for analysis. The overall quality of the concluding evidence was generally rated as low or very low. Performance bias and blind bias were found to be the main risk of bias of the included studies. In comparison to no treatment, manual therapy demonstrated a significant increase in pain relief in short-term (n=191, MD=1.30, 95% CI: 0.24~2.37). The differences in the effects of manual therapy and the placebo on pain intensity may not be statistically significant (n=255, MD=0.10, 95% CI: −0.37~0.58). In contrast to NSAIDs, manual therapy exhibited superior pain alleviation (n=507, MD=3.01, 95% CI: 1.08~4.94) and a higher effective rate (n=1029, OR=4.87, 95% CI: 3.29~7.20). Importantly, no severe adverse events were reported across all studies, indicating a relatively safe profile for manual therapy.

Conclusion

Manual therapy presented promise in effectively relieving menstrual pain with minimal adverse events in short term, outperforming both no treatment and NSAIDs. However, this conclusion is tempered by the low quality of the included RCTs, highlighting the necessity for more robust trials to validate it.

Keywords:

• primary dysmenorrhea
• manual therapy
• meta-analysis
• systematic review

Abbreviations

RCTs, randomized controlled trials; PD, primary dysmenorrhea; GRADE, grading of recommendations, assessment, development, and evaluation; NSAIDs, non-steroidal anti-inflammatory drugs; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analyses; MeSH, medical subject headings; VAS, Visual Analogue Scale; NRS, Numeric Rating Scale; MPQ, McGill Pain Questionnaire; MDQ, Moos Menstrual Distress questionnaire; MCID, minimum clinically important difference; ORs, odds ratios; CIs, confidence intervals; SMD, standardized mean difference; MD, mean difference.

Ethics Approval

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Beijing First Youth Outstanding Talent Project (No.2020-4-4195); Capital Clinical Characteristic Application Research (No.Z181100001718165); National Natural Science Foundation of China (No.81803956, 82374617); Central Public Welfare Research Institutes (ZZ-JQ2023002).