Multimodal Therapy Combining Spinal Manipulation, Transcutaneous Electrical Nerve Stimulation, and Heat for Primary Dysmenorrhea: A Prospective Case Study.

objectiveThe purpose of this case study was to report the effects of multimodal therapy as an adjunct to oral contraceptives on pain and menstrual symptoms in a patient with primary dysmenorrhea. CLINICAL FEATURES: A 27-year old nulligravid and nulliparous woman presented with low back pain, thigh pain, and menstrual symptoms associated with primary dysmenorrhea. Multimodal therapies (spinal manipulation, clinic-based transcutaneous electrical nerve stimulation, and heat applied at home) were delivered over 3 menstrual cycles. Outcome measures included pain (visual analogue scale) and menstrual symptoms (Menstrual Distress Questionnaire) from baseline to follow-up. She continued to take her oral contraceptives throughout the study period. INTERVENTION AND OUTCOME: For both low back and thigh pain, the patient reported clinically important differences in average pain and worst pain after 2 and 3 months from baseline. There were no clinically important differences in current pain, best pain, or menstrual symptoms at follow-up. No adverse events were reported.

conclusionSome of this patient's dysmenorrhea symptoms responded favorably to multimodal therapy over 5 months. The authors observed important short-term reductions in low back and thigh pain (average and worst pain intensity) during care.