Spinal manipulation for primary and secondary dysmenorrhoea

Area of Science:

• Integrative medicine
• Gynaecology
• Musculoskeletal medicine

Background:

• Dysmenorrhea, characterized by painful uterine cramps, is a prevalent gynecological condition.
• Spinal manipulation therapy (SMT) is explored as a treatment, with hypotheses linking vertebral dysfunction to altered nerve supply and pelvic blood flow.
• Alternatively, dysmenorrhea pain may be referred from musculoskeletal structures sharing pelvic nerve pathways.

Purpose of the Study:

• To evaluate the safety and efficacy of spinal manipulative interventions for primary or secondary dysmenorrhea.
• Comparisons included SMT versus itself, placebo, no treatment, or other medical interventions.

Main Methods:

• A systematic literature search was conducted across multiple databases (e.g., Cochrane, MEDLINE, EMBASE) up to March 2004.
• Randomized controlled trials (RCTs) of spinal manipulative interventions (chiropractic, osteopathy, manipulative physiotherapy) were included.
• Data extraction and quality assessment were performed independently, with meta-analysis for dichotomous and continuous outcomes.

Main Results:

• Four trials of high-velocity, low-amplitude (HVLA) manipulation indicated it was not more effective than sham manipulation for dysmenorrhea.
• One small trial suggested the Toftness technique was more effective than sham treatment, but lacked strong evidence.
• No significant difference in adverse effects was observed between SMT and sham treatments.

Conclusions:

• Current evidence does not support the effectiveness of spinal manipulation for treating primary and secondary dysmenorrhea.
• Spinal manipulation does not appear to pose a greater risk of adverse effects compared to sham manipulation.