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Spinal manipulation for primary and secondary dysmenorrhoea
M L Proctor1, W Hing, T C Johnson
1Department of Obstetrics and Gynaecology, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand, 1003. m.proctor@auckland.ac.nz
The Cochrane Database of Systematic Reviews
|November 1, 2001
Summary
Spinal manipulation therapy, including high-velocity, low-amplitude (HVLA) techniques, showed no significant effectiveness for treating dysmenorrhea compared to sham treatments. This therapy did not present a greater risk of adverse effects than sham manipulation.
Area of Science:
- Gynaecology
- Musculoskeletal Medicine
- Evidence-Based Medicine
Background:
- Dysmenorrhea, characterized by painful uterine cramps, affects a significant portion of women.
- Conventional treatments like NSAIDs and OCPs have limitations, including a 20-25% failure rate and adverse effects, prompting interest in alternative therapies.
- Spinal manipulation therapy is explored as a potential alternative, with hypotheses linking spinal mechanics to autonomic nerve supply and referred pain mechanisms in dysmenorrhea.
Purpose of the Study:
- To evaluate the safety and efficacy of spinal manipulative interventions for primary and secondary dysmenorrhea.
- To compare spinal manipulation against placebo, no treatment, or other medical interventions.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted using extensive electronic database searches.
- Five RCTs met the inclusion criteria, involving high-velocity, low-amplitude (HVLA) manipulation and the Toftness technique.
- Data were extracted and analyzed using meta-analysis for dichotomous and continuous outcomes, with pain relief/intensity and adverse effects as primary outcomes.
Main Results:
- Four trials on HVLA manipulation indicated it was not more effective than sham manipulation for dysmenorrhea, though possibly better than no treatment.
- One adequately sized trial found no difference between HVLA and sham treatment; adverse effects were similar between groups.
- The Toftness technique showed potential efficacy over sham treatment in one small trial, but conclusions were limited by sample size and methodology.
Conclusions:
- Current evidence does not support the effectiveness of spinal manipulation for treating primary or secondary dysmenorrhea.
- Spinal manipulation does not appear to carry a higher risk of adverse effects compared to sham manipulation.
- Further high-quality research is needed to definitively assess the role of spinal manipulation in dysmenorrhea management.