Primary Dysmenorrhea and Osteopathy. Can Osteopathy help?
Today, I’d like to talk about a problem that has a huge impact on the world’s female population, Primary Dysmenorrhea (PD). Before delving into the subject, it is appropriate to make a clarification. Dysmenorrhea can also be Secondary, in this case menstrual pain can originate from different gynaecological problems. The most common are endometriosis, adenomyosis, fibroids (myomas) and pelvic inflammatory disease. Today we will talk about the PD.
What is Primary Dysmenorrhea?
Dysmenorrhea, defined as painful menstrual cramps of uterine origin, is the most common gynaecological condition among women of reproductive age, irrespective of nationality. It affects between 45 and 95% of menstruating women. The prevalence of PD is highly underestimated, therefore difficult to determine. The main reason of this is that only few affected women seek medical treatment, despite the substantial distress experienced, as many consider the pain to be a normal part of the menstrual cycle rather than a disorder.
Systemic symptoms such as nausea, vomiting, diarrhoea, fatigue and insomnia, frequently accompany the cramping pain.
Many women would be surprised to know that suffering from pain during their period IS NOT normal.
For both Primary and Secondary Dysmenorrhea, researchers have highlighted different risk factors that would the chance to suffer from it: smoking, higher BMI (body mass index), alcohol consumption, family history of dysmenorrhea and nulliparity (never had children).
What’s the reason of the pain?
The most widely accepted explanation for the pathogenesis of PD is the overproduction of uterine Prostaglandins. Prostaglandins are pro-inflammatory molecules that cause the contraction of the uterine muscles, this to encourage the exfoliation of the endometrium in case of non-fertilization. A non-physiological situation, such as that of PD, overproduction of prostaglandins creates a hypercontractility of the myometrium, causing ischemia and hypoxia of the musculature and ultimately pain. Considering the Prostaglandin-based etiology of primary dysmenorrhea, the current most common pharmacological treatment for dysmenorrhea is non-steroidal anti-inflammatory drugs (NSAIDs).
Pain sensitivity and quality of life
Different studies found significant pain sensitivity in dysmenorrhea, which means that women suffering from this disorder have, in general throughout the body, a lower pain threshold than normal. This is crucial if you consider how much their life could be stressed by pain. Other studies showed menstrual pain has a negative impact on multiple aspects of the personal lives of those affected, including: family relationships, friendships, school/work performance, and social and recreational activities. This shows how impactful is on society the Primary Dysmenorrhea.
Review paper: Iacovides, S., Avidon, I., & Baker, F. C. (2015). What we know about primary dysmenorrhea today: a critical review. Human reproduction update, 21(6), 762-778.
Primary Dysmenorrhea, could Osteopathy help?
It is noted that PD symptoms are caused by highest peak of prostaglandin levels, which cause uterine contractions, inflammation and consequent ischemia that contribute to dysmenorrhea symptoms.(1)
In addition to the well known anti-inflammatory effects of the Osteopathic Manipulative Treatment (OMT)(2,3,4), there may be another mechanism through which osteopathic treatment may work.
There is a limited evidence concerning the increased secretion of the endocannabinoid anandamide (AEA), a mediator of inflammatory pain, and OMT(5,6). To strengthen this hypothesis, a research found that AEA releases nitric oxide (NO)(7). NO has been suggested as a vascular and neural signaling molecule through which OMT works(8). Furthermore, it has been demonstrated the presence of two cannabinoid receptors, CB1 and CB2, in the human endometrium and the fluctuation of AEA and others endocannabinoids during menstrual cycle(9). This possibly suggests another mechanism by which OMT could act, since cannabinoids are known to have anti-inflammatory proprieties.(10,11)
Other mechanisms of functioning of osteopathy for this disorder can be proposed. For example, it has been shown that osteopathy can have beneficial effects on the treatment of chronic pain(12), and Dysmenorrhea is a chronic pain. It has been seen how an hands-on treatment (by touch) can have inhibitory effects on nociceptive receptors (pain receptors) (13). In addition, several benefits have been identified that osteopathic treatment could have on psychological factors (which also affect the women with primary dysmenorrhea) (14).
References:
1. Jabbour, H. N., Kelly, R. W., Fraser, H. M., & Critchley, H. O. (2006). Endocrine regulation of menstruation. Endocrine reviews, 27(1), 17-46.
2. Standley, P. R., & Meltzer, K. (2008). In vitro modeling of repetitive motion strain and manual medicine treatments: potential roles for pro-and anti-inflammatory cytokines. Journal of bodywork and movement therapies, 12(3), 201-203.
3. Hicks, M. R., Cao, T. V., Campbell, D. H., & Standley, P. R. (2012). Mechanical strain applied to human fibroblasts differentially regulates skeletal myoblast differentiation. Journal of Applied Physiology, 113(3), 465-472.
4. Licciardone, J. C., Kearns, C. M., Hodge, L. M., & Bergamini, M. V. (2012). Associations of cytokine concentrations with key osteopathic lesions and clinical outcomes in patients with nonspecific chronic low back pain: results from the OSTEOPATHIC Trial. The Journal of the American Osteopathic Association, 112(9), 596-605.
5. Degenhardt, B.F., Darmani, N.A., Johnson, J.C., Towns, L.C., J. Rhodes, D.C., Trinh, C., McClanahan, B., DiMarzo, V. (2007). Role of Osteopathic Manipulative Treatment in Biomarkers Altering Pain: A Pilot Study. J. Am. Osteopath. Assoc., 107 (9): 387-400.
6. McPartland, J.M. (2008). The Endocannabinoid System: An Osteopathic Perspective. J. Am. Osteopath. Assoc.108(10):586-600.
7. Deutsch, D. G., Goligorsky, M. S., Schmid, P. C., Krebsbach, R. J., Schmid, H. H., Das, S. K., … & Moore, L. C. (1997). Production and physiological actions of anandamide in the vasculature of the rat kidney. Journal of Clinical Investigation, 100(6), 1538.
8. Salamon, E., Zhu, W., & Stefano, G. B. (2004). Nitric oxide as a possible mechanism for understanding the therapeutic effects of osteopathic manipulative medicine. International journal of molecular medicine, 14(3), 443-449.
9. Taylor, A. H., Abbas, M. S., Habiba, M. A., & Konje, J. C. (2010). Histomorphometric evaluation of cannabinoid receptor and anandamide modulating enzyme expression in the human endometrium through the menstrual cycle. Histochemistry and cell biology, 133(5), 557-565.
10. Walker, J. M., & Huang, S. M. (2002). Endocannabinoids in pain modulation. Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA), 66(2-3), 235-242.
11. Ashton, J. C. (2007). Cannabinoids for the treatment of inflammation. Current opinion in investigational drugs (London, England: 2000), 8(5), 373-384.
12. Licciardone, J. C., Kearns, C. M., & Minotti, D. E. (2013). Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Manual therapy, 18(6), 533-540.
13. Mancini, F., Beaumont, A. L., Hu, L., Haggard, P., & Iannetti, G. D. D. (2015). Touch inhibits subcortical and cortical nociceptive responses. Pain, 156(10), 1936.
14. Saracutu, M., Rance, J., Davies, H., & Edwards, D. J. (2017). The effects of osteopathic treatment on psychosocial factors in people with persistent pain: A systematic review. International Journal of Osteopathic Medicine.
