Effectiveness of Pain Neuroscience Education in Women With Menstrual Pain

Menstruation is the bleeding that starts with menarche and continues until menopause, along with hormonal changes in women of reproductive age, and is shed as the endometrium matures and is shed. Menstruation, which covers 30-35 years of a woman's life and occurs regularly every month, is a physiological process. Menstrual cycle problems are a condition that affects health and society all over the world and causes treatment to be sought. It is one of the most common menstrual cycle problems.

Dysmenorrhea is used synonymously with menstrual pain in clinics and practice. It is stated that approximately 40-50% of women experience dysmenorrhea and that it is more common in adolescents. Dysmenorrhea is a symptom that causes changes in women's physical activities and social roles, leading to a decrease in their quality of life. Dysmenorrhea usually manifests itself with symptoms such as pain and cramps in the back and lower abdomen, as well as nausea, vomiting, fatigue, irritability, appetite changes, diarrhea, and headache.

According to the literature, among the choices of women to cope with dysmenorrhea, manipulative and body-based practices (massage, relaxation exercises, acupuncture, aromatherapy, hot-cold applications, etc.), mind-body-based practices (meditation, yoga, hypnotherapy, hypnosis, music therapy, etc.), vitamin-mineral supplements and herbal therapies (vitamins B and E, magnesium, zinc, fennel/rose tea, black cohosh, etc.) and exercise programs are seen to be effective.

Study Overview

• Status: Completed
• Conditions: Pain Management; Dysmenorrhea (Disorder)
• Intervention / Treatment: Other: Pain Neuroscience Education (PNE); Other: Control Group (CG)

Detailed Description

The first concepts of pain neuroscience education emerged in 2002 in a randomized controlled trial conducted by Lorimer Moseley for patients with low back pain. PNE has been given various names, including but not limited to pain biology education, pain neurophysiology education, neuroscientific pain education, and neuroscience education. In general, PNE is an educational intervention that aims to explain to the patient the neurophysiology of pain, nervous system sensitivity, nervous system plasticity, and psychosocial factors that contribute to the experience of persistent pain. This is accomplished through a series of intertreatment educational modules spread over a term. The modules include exposure to visual aids, examples, and metaphors to enhance patient understanding. The duration and frequency of educational sessions are not uniform in the literature; they range from 30 minutes to 4 hours. Pain neuroscience education connects the pathoanatomical model of tissue damage with the neurophysiological and psychosocial factors inherent in the experience of persistent pain. The goal is to help patients reconceptualize their pain experience by providing educational content that can reduce focus on anatomic damage, decrease fear avoidance, reduce kinesiophobia, and improve self-efficacy. The exact dosage, frequency, and content of a PNE intervention vary.

There are studies in the literature examining the effectiveness of PNE in chronic low back pain, chronic whiplash injury, chronic fatigue syndrome, and the postoperative and preoperative periods of lumbar surgery. No study was found using the pain neuroscience education method in clients with menstrual period pain.

The aim of this study was to investigate the effectiveness of pain neuroscience education on pain and quality of life in women with menstrual period pain.

• Study Type: Interventional
• Enrollment (Actual): 74
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34000
    • Uskudar University, Faculty of Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Being over 18 years of age,
• Not having a previous pregnancy,
• Not having a history of pelvic infections
• Not using hormonal contraception and intrauterine devices,
• Having a menstrual period of 3-8 days and a menstrual cycle interval of 21-35 days,
• Being willing to participate in the study.

Exclusion Criteria:

• Being under 18 years of age,
• Having a previous pregnancy,
• Having a history of pelvic infections
• Using hormonal contraception and intrauterine devices,
• Not having a menstrual period of 3-8 days and a menstrual cycle interval of 21-35 days,
• Not being willing to participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pain neuroscience education group (PNE); The cases in this group will be given online PNE training one week before menstruation.	Other: Pain Neuroscience Education (PNE); PNE was planned online for clients 1 week before menstruation in the form of speaking sessions in a presentation format. The training will be conveyed in relation to pain during menstruation. Visual aids, examples and metaphors will be used to improve patient understanding in the training. Ankle sprain picture, speeding bus picture, action potential picture, picture showing membrane resting potential, rusty nail picture, whole body nervous system picture, neuromatrix picture, lion and lion cub picture that helps explain stress responses, curious neighbors picture etc. will be used. The training session is planned to last between 2 and 4 hours. The distribution of pain neuroscience training topics will be implemented in the order given below, with 10 main headings.; Pain and the Biopsychosocial Model; Injury and pain are not equivalent, pain is a brain output rather than an input; Action potential, normal electrical activity of nerves and conduction; Biological process of ion chann
Other: Control Group (CG); No training or application will be given to the control group	Other: Control Group (CG); The control group will not receive any training or practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Scale for Assessing the Impact of Dysmenorrhea on Daily Life (SAIDDL)	The Scale for Assessing the Impact of Dysmenorrhea on Daily Life was prepared to determine and compare the extent to which daily life is affected by the pain experienced during menstruation. On the 3rd day of each menstrual period, the degree to which daily life is affected is marked on the horizontal line with the numerical values between 0 and 10. A score of 0 on the scale indicates that daily life is "not affected at all" by dysmenorrhea, while a score of 10 indicates that it is "completely affected".	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Beliefs Scale (BPS)	It was developed by Edwards and colleagues in 1992. It has an 8-item Organic Beliefs subtest (items 1, 2, 3, 5, 7, 8, 10, 11) and a 4-item Psychological Beliefs subtest (items 4, 6, 9, 12). When the scale is applied, the person is asked to mark the most appropriate option for themselves from 6 options ranging from "never" to "always". Scoring varies between 1 and 6 for each item. The total score for each subtest is calculated by adding the scores from the items in the relevant subtest and dividing them by the number of items in the relevant subtest, and three score types (organic beliefs subscale, psychological beliefs subscale, and total score) are obtained.	4 weeks
McGill Pain Scale Short Form (MSS-SF)	The McGill Pain Scale Short Form consists of three sections. Section One: This section contains 15 descriptive word groups. 11 of these evaluate the sensory and 4 evaluate the perceptual dimensions of pain. These descriptive words are rated on an intensity scale between 0 and 3 (0=none, 1=mild, 2=moderate, 3=extreme). In the first section of the scale, a total of 3 pain scores are obtained: sensory pain score, perceptual pain score, and total pain score. Section Two: The second section of the form contains five word groups ranging from "mild pain" to "unbearable pain" to determine the severity of the patient's pain. Section Three: In the third section, the patient's current pain intensity is evaluated using a visual comparison scale.	4 weeks

Collaborators and Investigators

• Sponsor: Uskudar University
• Investigators: Study Director: osman coban, Asst Prof., Uskudar University; Principal Investigator: cigdem inkaya, PT, Uskudar University

Publications and helpful links

General Publications

• Zimney K, Van Bogaert W, Louw A. The Biology of Chronic Pain and Its Implications for Pain Neuroscience Education: State of the Art. J Clin Med. 2023 Jun 21;12(13):4199. doi: 10.3390/jcm12134199.
• O'Connor M, Sillevis R, Erickson MR. Pain Neuroscience Education Delivered by a Student Physical Therapist for a Patient with Persistent Musculoskeletal Pain. Am J Case Rep. 2021 Aug 16;22:e932212. doi: 10.12659/AJCR.932212.
• Louw A, Farrell K, Choffin B, Foster B, Lunde G, Snodgrass M, Sweet R, Weitzel M, Wilder R, Puentedura EJ. Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial. J Man Manip Ther. 2019 Dec;27(5):267-276. doi: 10.1080/10669817.2019.1624006. Epub 2019 Jun 4.
• Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ. 2021 May 31;9:e11543. doi: 10.7717/peerj.11543. eCollection 2021.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2024
• Primary Completion (Actual): January 31, 2025
• Study Completion (Actual): February 1, 2025

Study Registration Dates

• First Submitted: December 9, 2024
• First Submitted That Met QC Criteria: December 12, 2024
• First Posted (Actual): December 13, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 12, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: pain; quality of life; pain neuroscience education; dysmenorrhea
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathologic Processes; Pelvic Pain; Menstruation Disturbances; Dysmenorrhea
• Other Study ID Numbers: Uskudaruniversity5

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No