The present studies were designed to investigate responsiveness of women to laboratory pain. The purpose of this investigation was manifold in that the effects of several different variables on pain perception were examined. First, the studies sought to determine whether the experience of menstrual pain, otherwise known as dysmenorrhea, had any relationship to the perception of laboratory induced pain, namely, cold pressor pain. Second, it was asked whether menstrual phase had any relationship either on its own, or in interacting with dysmenorrhea, to pain perception. Third, based on observations from the two previous studies, it was asked whether age and/or previous experience of childbirth pain had any influence on pain perception. The first study employed a within-subjects design of young university women in order to investigate the relationship of dysmenorrhea and menstrual cycle phase to pain threshold, tolerance, and subjective pain intensity ratings. The second study employed a between-subjects design of young university women as well, in order to replicate the menstrual phase effect obtained in the first study. The third study employed a between-subjects design of older women as it dealt with the relationships of age and/or the experience of childbirth pain to the same measures of pain perception. It also dealt with defining further characteristics of dysmenorrhea as occurring in an older group of women (over 30 yrs of age). Results from the first two studies indicated a significant increase in pain sensitivity, measured as pain threshold, from the follicular to the luteal phase of the cycle but no overall significant effects of dysmenorrhea on laboratory-induced pain. In the second study, there was a significant interaction between menstrual phase and dysmenorrhea with respect to subjective pain ratings. These results partially replicated previous findings in the literature while employing a clinically relevant method of pain induction. Results from the third study indicated that previous experience of childbirth pain, independent of age, is a significant factor in the perception of laboratory-induced pain. These latter results have never before been reported in the pain literature and thus deserve further investigation. Possible implications for an adaptation-levels model are discussed. / Thesis / Doctor of Philosophy (PhD)

The purpose of this cross-sectional, correlational study was to validate the factors that are related to dysmenorrhea in Taiwanese adolescents. The specific aims were to describe the perceived dysmenorrhea pain symptom experience (SE), related self-care strategies (SCS), and perceived effectiveness of self-care strategies (PESS); to explore the relationships between SE, SCS, and PESS; and to explore the influence of contextual factors on SE, SCS, and PESS. A conceptual framework based on the revised Symptom Management Model was developed and guided this study. A nonprobability sample of 165 adolescent participants was recruited from a technology university located in southern Taiwan. Inclusion criteria for participants were: (1) Taiwanese female adolescent, (2) age 15-19 years old, and (3) willing to participate in this study. All participants and their parents completed the consent forms and completed the questionnaires in their classrooms during free studying time. Five instruments were used and data was analyzed by using the SPSS Version 14.0 including descriptive statistical techniques, Pearson’s correlations, ANOVA, and multiple regression analysis. The findings showed the prevalence of dysmenorrhea in this sample was 87.3%. There were 82.4% of participants who reported dysmenorrhea had influenced their daily activity, and 12.7% of participants who reported school absenteeism because of dysmenorrhea. Most of participants used self–care strategies for dysmenorrhea including avoiding cold food or drinks, drinking brown sugar and ginger soup, etc. The most frequently used self-care strategies and their effectiveness were described. Age, age of the first period, total menstrual years, eating cold food or drinks, self-care strategies, and mother’s perceived support of self-care strategies were significantly related to the log of symptom experience of dysmenorrhea. Total menstrual years and self-care strategies were identified as significant predictors of dysmenorrhea. This study added to the body of nursing science regarding dysmenorrhea in Taiwanese adolescents. In particular, the findings supported the existence of relationships between self-care strategies and perceived effectiveness of self-care strategies. Building on these findings, future research should be conducted to design interventions that reduce the pain associated with dysmenorrhea for this population. / text

A dismenorreia primária ou menstruação dolorosa na ausência de patologia pélvica é uma condição comum e muitas vezes debilitante considerada uma das queixas mais frequentes no dia-a-dia da clínica ginecológica, afetando entre 45 e 95% das mulheres que menstruam. Não há consenso na literatura sobre os limiares experimentais dessas mulheres. Na dor pélvica crônica, a diminuição dos limiares sensitivo e doloroso estão associados aos quadros de sensibilização central e hiperalgesia, necessitando de tratamento focado nesse quadro sindrômico. Se os limiares dolorosos das mulheres com dismenorreia seguirem um padrão compatível como o encontrado em mulheres com dor pélvica crônica, poderemos melhorar o tratamento dessas pacientes, abordando também as alterações neuroplásticas e do humor. Objetivo primário: Avaliar os limiares experimentais de voluntárias portadoras de dismenorreia primária moderada ou grave. Métodos e Procedimentos: Na entrevista, as participantes foram submetidas a uma avaliação psicométrica com as escalas EVA (escala visual analógica de dor), Questionário de McGill (analisa várias dimensões da dor), Escala de Ansiedade e Depressão para Hospital Geral (HAD), avaliação sócio-demográfica, antropométrica e ainda um questionário relacionado ao ciclo menstrual em geral, abordando ainda questões relacionadas a história familiar, absenteísmo no trabalho ou escola, uso e eficiência medicamentosa, prática e frequência de atividade física, entre outras. Em seguida, foram analisados os limiares sensitivo e doloroso através do aparelho de eletroestimulação nervosa transcutânea TENS e o limiar doloroso por meio de pressão transcutânea, algômetro. Resultados: Participaram do estudo 48 voluntárias divididas em dois grupos: Grupo Estudo, composto por 24 mulheres (com dismenorreia primária moderada ou grave) e o Grupo Controle composto por 24 mulheres (sem dismenorreia ou com dismenorreia primária leve). A mediana do limiar doloroso obtido através da estimulação nervosa transcutânea foi de 10,11mA no grupo de estudo e 11,92mA no grupo controle e na algometria de 1,86kg/cm² e 2,28kg/cm² respectivamente. Entre as mulheres com dismenorreia primária moderada ou grave 70 % relataram que a mãe ou irmã já sofreram ou sofrem de cólicas menstruais, 70 % não praticam nenhum tipo de atividade física, 58,3%possui algum grau de ansiedade pelo HAD e 12,5% de depressão pelo HAD, 87,5% fazem uso de medicação para dor durante o período menstrual e 33,3% faltaram de suas atividades nos últimos três meses devido a dismenorreia. / Primary dysmenorrhea or painful menstruation in the absence of pelvic pathology is a common condition and often debilitating considered one of the most frequent complaints in day-to-day gynecologic practice, affecting between 45 and 95% of menstruating women. There is no consensus in the literature on the experimental thresholds of these women In chronic pelvic pain, decreased sensory and pain thresholds are associated with the frames of central sensitization and hyperalgesia, requiring treatment focused on this syndromic. If the painful threshold of women with dysmenorrhea follow a pattern consistent as found in women with chronic pelvic pain, we can improve the treatment of these patients also addressing the neuroplastic and mood changes. Specific Objective: Evaluate voluntary experimental thresholds with moderate or severe primary dysmenorrhea. Methods and Procedures: In the interview, participants were subjected to psychometric assessment to the VAS scales (visual analog pain scale), McGill Questionnaire (analyzes various dimensions of pain), Anxiety Scale and Depression for General Hospital (HAD), socio-demographic, antropometric assessment and also a questionnaire related to the menstrual cycle in general, adressing issues related to family history, absenteeism at work or school, use and drug efficiency, practice and frequency of physical activity, among others. Then the sensitive and painful thresholds were analyzed through transcutaneous electrical nerve stimulation TENS device and the pain threshold through transcutaneous pressure algometer. Results: The study included 48 volunteers divided into two groups: Study Group, composed of 24 women (with moderate or severe primary dysmenorrhea), the control group composed of 24 women (no or mild dysmenorrhea primary dysmenorrhea). The median pain threshold obtained by transcutaneous nerve stimulation was 10,11mA corresponding to the study group and the control group 11,92mA and algometry of 1,86kg / cm² and 2,28kg / cm² respectively. Among women with moderate or severe primary dysmenorrhea 70 % reported that the mother or sister have suffered or are suffering from menstrual cramps, 70 % do not practice any physical activity, 58.3 % have some degree of anxiety by the HAD and 12.5 % of depression by the HAD, 87.5 % make use of medication for pain during the menstrual period and 33.3 % missed their activities in the last three months because of dysmenorrheal.

A dismenorreia primária ou menstruação dolorosa na ausência de patologia pélvica é uma condição comum e muitas vezes debilitante considerada uma das queixas mais frequentes no dia-a-dia da clínica ginecológica, afetando entre 45 e 95% das mulheres que menstruam. Não há consenso na literatura sobre os limiares experimentais dessas mulheres. Na dor pélvica crônica, a diminuição dos limiares sensitivo e doloroso estão associados aos quadros de sensibilização central e hiperalgesia, necessitando de tratamento focado nesse quadro sindrômico. Se os limiares dolorosos das mulheres com dismenorreia seguirem um padrão compatível como o encontrado em mulheres com dor pélvica crônica, poderemos melhorar o tratamento dessas pacientes, abordando também as alterações neuroplásticas e do humor. Objetivo primário: Avaliar os limiares experimentais de voluntárias portadoras de dismenorreia primária moderada ou grave. Métodos e Procedimentos: Na entrevista, as participantes foram submetidas a uma avaliação psicométrica com as escalas EVA (escala visual analógica de dor), Questionário de McGill (analisa várias dimensões da dor), Escala de Ansiedade e Depressão para Hospital Geral (HAD), avaliação sócio-demográfica, antropométrica e ainda um questionário relacionado ao ciclo menstrual em geral, abordando ainda questões relacionadas a história familiar, absenteísmo no trabalho ou escola, uso e eficiência medicamentosa, prática e frequência de atividade física, entre outras. Em seguida, foram analisados os limiares sensitivo e doloroso através do aparelho de eletroestimulação nervosa transcutânea TENS e o limiar doloroso por meio de pressão transcutânea, algômetro. Resultados: Participaram do estudo 48 voluntárias divididas em dois grupos: Grupo Estudo, composto por 24 mulheres (com dismenorreia primária moderada ou grave) e o Grupo Controle composto por 24 mulheres (sem dismenorreia ou com dismenorreia primária leve). A mediana do limiar doloroso obtido através da estimulação nervosa transcutânea foi de 10,11mA no grupo de estudo e 11,92mA no grupo controle e na algometria de 1,86kg/cm² e 2,28kg/cm² respectivamente. Entre as mulheres com dismenorreia primária moderada ou grave 70 % relataram que a mãe ou irmã já sofreram ou sofrem de cólicas menstruais, 70 % não praticam nenhum tipo de atividade física, 58,3%possui algum grau de ansiedade pelo HAD e 12,5% de depressão pelo HAD, 87,5% fazem uso de medicação para dor durante o período menstrual e 33,3% faltaram de suas atividades nos últimos três meses devido a dismenorreia. / Primary dysmenorrhea or painful menstruation in the absence of pelvic pathology is a common condition and often debilitating considered one of the most frequent complaints in day-to-day gynecologic practice, affecting between 45 and 95% of menstruating women. There is no consensus in the literature on the experimental thresholds of these women In chronic pelvic pain, decreased sensory and pain thresholds are associated with the frames of central sensitization and hyperalgesia, requiring treatment focused on this syndromic. If the painful threshold of women with dysmenorrhea follow a pattern consistent as found in women with chronic pelvic pain, we can improve the treatment of these patients also addressing the neuroplastic and mood changes. Specific Objective: Evaluate voluntary experimental thresholds with moderate or severe primary dysmenorrhea. Methods and Procedures: In the interview, participants were subjected to psychometric assessment to the VAS scales (visual analog pain scale), McGill Questionnaire (analyzes various dimensions of pain), Anxiety Scale and Depression for General Hospital (HAD), socio-demographic, antropometric assessment and also a questionnaire related to the menstrual cycle in general, adressing issues related to family history, absenteeism at work or school, use and drug efficiency, practice and frequency of physical activity, among others. Then the sensitive and painful thresholds were analyzed through transcutaneous electrical nerve stimulation TENS device and the pain threshold through transcutaneous pressure algometer. Results: The study included 48 volunteers divided into two groups: Study Group, composed of 24 women (with moderate or severe primary dysmenorrhea), the control group composed of 24 women (no or mild dysmenorrhea primary dysmenorrhea). The median pain threshold obtained by transcutaneous nerve stimulation was 10,11mA corresponding to the study group and the control group 11,92mA and algometry of 1,86kg / cm² and 2,28kg / cm² respectively. Among women with moderate or severe primary dysmenorrhea 70 % reported that the mother or sister have suffered or are suffering from menstrual cramps, 70 % do not practice any physical activity, 58.3 % have some degree of anxiety by the HAD and 12.5 % of depression by the HAD, 87.5 % make use of medication for pain during the menstrual period and 33.3 % missed their activities in the last three months because of dysmenorrheal.

Submitted in partial compliance with the requirements of the Master’s Degree in Technology in Homoeopathy, Durban University of Technology, Durban, South Africa, 2018. / Dysmenorrhoea is the term used to describe painful menstrual cramps, and is the most commonly encountered gynaecological disorder. It affects more than 50% of women of reproductive age, of which 10% to 12% experience severe dysmenorrhoea that interferes with their daily lives by incapacitating them for 1 to 3 days each month. Dysmenorrhoea is estimated to be the single greatest cause of working hours lost by women and school absence in teenage girls (Dawood 2008; Lindeque 2015: 6-9). Primary dysmenorrhoea is defined as painful, spasmodic cramping in the lower abdomen just before and/or during menstrual bleeding, in the absence of any identifiable macroscopic pathology. It is related to increased levels of inflammatory markers such as vasopressin, prostaglandins (PGF2α) and leukotrienes from the secretory endometrium. These induce ischaemia due to excessive prolonged uterine contractions, increased the sensitivity of pain fibres, and cause vasoconstriction (Iacovides, Avidon and Baker 2015: 1-17; Stewart and Deb 2014: 296-302). This double-blinded randomised study aimed to establish the efficacy of a homoeopathic complex (consisting of Angelica sinensis 6cH, Dioscorea villosa 6cH, Matricaria chamomilla 6cH, Viburnum opulus 6cH and Zingiber officinalis 6cH) compared to a homoeopathic similimum in 30cH plussed potency in the treatment of the symptoms of primary dysmenorrhoea, in terms of the participants’ perception of the treatment. Thirty female students, who signed the inform consent forms (Appendices B and D), from the Durban University of Technology were selected based on specified inclusion and exclusion criteria after they underwent an abdominal ultrasound examination (Appendix D) by a gynaecologist. They were randomly divided by means of convenience sampling according to a randomisation sheet into two groups. There were 20 in the experimental group which received the homoeopathic complex, and 10 in the control group which received the homoeopathic similimum. The study took place at the Homoeopathic Day Clinic, located at the Durban University of Technology. It was conducted over a period of three menstrual cycles per participant. The initial consultation took place prior to a menstrual period and the subsequent three follow-ups took place once a month, a week after each menstrual period. During each consultation, a detailed homoeopathic case history was conducted and a physical examination including an abdominal examination was performed. In addition, the participants were required to complete the Moos Menstrual Distress Questionnaire (Moos 1968) (Appendix G) and the Pain Rating Scale (British Pain Society 2006) (Appendix H). SPSS version 23.0 software was used to analyse the data collected from these questionnaires. The quantitative variables across the groups were compared using the Kruskal-Wallis test since the captured data was non-parametric. The one-way analysis of variance (ANOVA) was used to compare intra-group data. Quantitative variables were expressed as a mean ± standard deviation. A p-value less than 0.05 was considered significant. The intra-group analysis using the PRS and the MDQ scales (Appendices G and H) showed statistically significant changes in the subcategories of pain in the simillimum group, while these changes were noticed in the complex group only with the PRS scale, when different follow up mean pain score was compared to that at baseline. The different comparisons and p-values can be found in the Appendix G1. The homoeopathic complex group showed more statistically significant changes in the subcategories of behaviour change, negative affect, and control (Appendix G1); while the homoeopathic similimum also revealed other statistically significant changes in the autonomic response and appetite change subgroups (Appendix G1). The inter-group analysis did not reveal any statistically significant change between the groups, although a decrease in the majority of the various mean scores was observed throughout the study. The study’s results led to the conclusion that both the homoeopathic complex and homoeopathic similimum were effective (Appendix G1) in the treatment of symptoms of primary dysmenorrhoea during various follow-ups, as well as reducing the need for allopathic pain medications in the participants during the study. However that efficacy shown by the presence of statistically significant results could not been maintained throughout the study from the baseline to the third follow-ups, this could be due to the smaller sample size of the participants, the need for a better suited similimum remedy with a higher potency for the control group; or the need for another complex remedy, It was also noted that there was no evidence that one treatment was more beneficial than the other even though a decrease in the mean scores was observed in both groups. / M

<p><em>Bakgrund</em>: Primär dysmenorré, svår menstruationssmärta utan sjukdomsrelaterad bakomliggande orsak, är det vanligaste gynekologiska besväret för unga kvinnor. Idag fokuseras behandlingen av menstruationssmärta på läkemedel. Det har dock visats att kvinnor även använder sig av ickefarmakologiska metoder för att lindra sin smärta. Syftet med denna litteraturöversikt var att undersöka om det finns evidens för att följande ickefarmakologiska behandlingsmetoder kan lindra primär dysmenorré: akupunktur, akupressur, kostvanor och kostterapi, massage, transkutan elektrisk nervstimulering (TENS), värme samt örtterapi.</p><p><em>Metod</em>: Sökningar genomfördes i databaserna AMED, CINAHL, Cochrane Library samt Pubmed. På grund av få artikelträffar och låg kvalitet hos artiklarna exkluderades massage och värme. Totalt inkluderades 18 engelskspråkiga artiklar, publicerade mellan år 1999-2009, vilka redovisade resultat från sammanlagt 92 studier. Sammanlagt 23 studier undersökte akupunktur, 11 undersökte akupressur, 46 undersökte örtterapi, 3 undersökte kostterapi och kostvanor samt 9 undersökte TENS. Kvalitetsgranskning genomfördes enligt en mall från Forsberg & Wengström (2008).</p><p><em>Resultat</em>: Det finns evidens för att akupressur, TENS och örtterapi lindrar primär dysmenorré. Vilka specifika akupunkter och örter som har en smärtlindande effekt är dock oklart. Sjuksköterskan kan ge råd till patienter med primär dysmenorré att prova TENS för att lindra sina menstruationssmärtor.</p> / <p><em>Background</em>: Primary dysmenorrhea, menstrual pain without disease-related underlying reason, is the most common gynaecological discomfort for young women. Today the treatment regime for menstrual pain is focused on pharmacologic treatments. However, it has been observed that women also use non-pharmacologic methods to ease their pain. The objective for this literature review was to determine if there is evidence for the following non- pharmacologic treatment-methods to ease primary dysmenorrhea: acupuncture, acupressure, dietary habits and dietary therapies, massage, transcutaneous electrical nerve stimulation (TENS), heat and herbal therapy.</p><p><em>Method</em>: Searches were performed in databases AMED, CINAHL, Cochrane Library and PubMed. Because of a small number of search-results and low quality of the articles massage and heat was excluded. A total of 18 English-speaking articles published between 1999-2009 were identified. They reviewed results from 92 studies. Altogether 23 studies reviewed acupuncture, 11 acupressure, 46 herbal therapy, 3 dietary therapies and dietary habits and 9 TENS. Quality assessment was performed according to a template from Forsberg & Wengström (2008).</p><p><em>Results</em>: There is evidence that acupressure, TENS and herbal therapy ease primary dysmenorrhea. Which specific acupoints and herbs that are pain relieving could not be concluded. The nurse can give advice to patients with primary dysmenorrhea to test TENS to ease their menstrual pain.</p>

Bakgrund: Primär dysmenorré, svår menstruationssmärta utan sjukdomsrelaterad bakomliggande orsak, är det vanligaste gynekologiska besväret för unga kvinnor. Idag fokuseras behandlingen av menstruationssmärta på läkemedel. Det har dock visats att kvinnor även använder sig av ickefarmakologiska metoder för att lindra sin smärta. Syftet med denna litteraturöversikt var att undersöka om det finns evidens för att följande ickefarmakologiska behandlingsmetoder kan lindra primär dysmenorré: akupunktur, akupressur, kostvanor och kostterapi, massage, transkutan elektrisk nervstimulering (TENS), värme samt örtterapi. Metod: Sökningar genomfördes i databaserna AMED, CINAHL, Cochrane Library samt Pubmed. På grund av få artikelträffar och låg kvalitet hos artiklarna exkluderades massage och värme. Totalt inkluderades 18 engelskspråkiga artiklar, publicerade mellan år 1999-2009, vilka redovisade resultat från sammanlagt 92 studier. Sammanlagt 23 studier undersökte akupunktur, 11 undersökte akupressur, 46 undersökte örtterapi, 3 undersökte kostterapi och kostvanor samt 9 undersökte TENS. Kvalitetsgranskning genomfördes enligt en mall från Forsberg &amp; Wengström (2008). Resultat: Det finns evidens för att akupressur, TENS och örtterapi lindrar primär dysmenorré. Vilka specifika akupunkter och örter som har en smärtlindande effekt är dock oklart. Sjuksköterskan kan ge råd till patienter med primär dysmenorré att prova TENS för att lindra sina menstruationssmärtor. / Background: Primary dysmenorrhea, menstrual pain without disease-related underlying reason, is the most common gynaecological discomfort for young women. Today the treatment regime for menstrual pain is focused on pharmacologic treatments. However, it has been observed that women also use non-pharmacologic methods to ease their pain. The objective for this literature review was to determine if there is evidence for the following non- pharmacologic treatment-methods to ease primary dysmenorrhea: acupuncture, acupressure, dietary habits and dietary therapies, massage, transcutaneous electrical nerve stimulation (TENS), heat and herbal therapy. Method: Searches were performed in databases AMED, CINAHL, Cochrane Library and PubMed. Because of a small number of search-results and low quality of the articles massage and heat was excluded. A total of 18 English-speaking articles published between 1999-2009 were identified. They reviewed results from 92 studies. Altogether 23 studies reviewed acupuncture, 11 acupressure, 46 herbal therapy, 3 dietary therapies and dietary habits and 9 TENS. Quality assessment was performed according to a template from Forsberg &amp; Wengström (2008). Results: There is evidence that acupressure, TENS and herbal therapy ease primary dysmenorrhea. Which specific acupoints and herbs that are pain relieving could not be concluded. The nurse can give advice to patients with primary dysmenorrhea to test TENS to ease their menstrual pain.

Thesis (M.CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references (leaves 24-26).

The use of relaxation, desensitization, and relaxation plus desensitization in the treatment of primary dysmenorrhea was investigated in this study. Subjects were 45 university women who experienced either congestive or spasmodic dysmenorrhea. Each subject was individually treated in four, one-hour sessions during the first 20 days of her menstrual cycle. Subjects were divided into three groups: Group 1 obtained four hours of progressive relaxation training, group 2 was asked to self-relax while being administered scenes from a standardized menstrual hierarchy, and group 3 obtained both relaxation training and desensitization. Type of dysmenorrhea was assessed by the Menstrual Symptom Questionnaire (MSQ). Symptom intensity and duration were assessed by the Retrospective Symptom Scale, the Menstrual Semantic Differential, the Menstrual Activities Scale, and the Menstrual Behavior Scale, and were administered pre-test, posttest, and three-month follow-up. Skin temperature during session 4 was obtained to evaluate the level of relaxation. Differences among treatment groups were analyzed using a one-way analysis of variance. t-tests for correlated samples were used to analyze within group changes form pretreatment to posttreatment. Results suggest all three treatments to be equally effective in reducing symptoms, negative attitudes, pain mitigating behaviors, and invalid hours. Symptom relief was not associated with skin temperature increases. The possibility of placebo playing a role in these results cannot be ruled out. Finally, the division of primary dysmenorrhea into spasmodic and congestive types by the MSQ is inaccurate, most probably due to the confounding nature of the scoring system.

No description available.