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Review
. 2024 May 6:17:1663-1681.
doi: 10.2147/JPR.S457381. eCollection 2024.

Manual Therapy in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Xia Li #  1 , Yanan Sun #  2 , Yuhan Wang  1 , Xiyou Wang  1 , Changhe Yu  1
Affiliations
Review

Manual Therapy in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Xia Li et al. J Pain Res. .

Abstract

Objective: This research aimed to assess the effectiveness of manual therapy in alleviating pain among women undergoing primary dysmenorrhea (PD).

Methods: All randomized controlled trials (RCTs) regarding manual therapy for PD were searched from online databases, spanning from their inception to July 2023. The identified literature underwent a thorough screening process, and the data were meticulously extracted and analyzed using RevMan 5.3. Subsequently, the included studies underwent Cochrane's quality assessment and meta-analysis. The evidence obtained was then assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.

Results: 32 RCTs, involving 2566 women were finally included for analysis. The overall quality of the concluding evidence was generally rated as low or very low. Performance bias and blind bias were found to be the main risk of bias of the included studies. In comparison to no treatment, manual therapy demonstrated a significant increase in pain relief in short-term (n=191, MD=1.30, 95% CI: 0.24~2.37). The differences in the effects of manual therapy and the placebo on pain intensity may not be statistically significant (n=255, MD=0.10, 95% CI: -0.37~0.58). In contrast to NSAIDs, manual therapy exhibited superior pain alleviation (n=507, MD=3.01, 95% CI: 1.08~4.94) and a higher effective rate (n=1029, OR=4.87, 95% CI: 3.29~7.20). Importantly, no severe adverse events were reported across all studies, indicating a relatively safe profile for manual therapy.

Conclusion: Manual therapy presented promise in effectively relieving menstrual pain with minimal adverse events in short term, outperforming both no treatment and NSAIDs. However, this conclusion is tempered by the low quality of the included RCTs, highlighting the necessity for more robust trials to validate it.

Keywords: manual therapy; meta-analysis; primary dysmenorrhea; systematic review.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flowchart. Adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178–189. Creative Commons.
Figure 2
Figure 2
Risk of bias graph: review of the authors’ judgments regarding each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary: review of the authors’ judgments regarding each risk of bias item in each included study.
Figure 4
Figure 4
Overall and different follow-up times subgroup forest plot of weighted mean difference (95% CI) for pain intensity for manual therapy versus no treatment.
Figure 5
Figure 5
Overall and various manual therapies subgroup forest plot of weighted mean difference (95% CI) for pain intensity for manual therapy versus no treatment.
Figure 6
Figure 6
Overall and various manual therapies subgroup forest plot of weighted OR (95% CI) for effective rate for manual therapy versus no treatment.
Figure 7
Figure 7
Overall and different follow-up times subgroup forest plot of weighted mean difference (95% CI) for MDQ for manual therapy versus no treatment.
Figure 8
Figure 8
Forest plot of weighted mean difference (95% CI) for pain intensity for manual therapy versus place control.
Figure 9
Figure 9
Overall and various manual therapies subgroup forest plot of weighted mean difference (95% CI) for pain intensity for manual therapy versus NSAIDs.
Figure 10
Figure 10
Overall and different follow-up times subgroup forest plot of weighted mean difference (95% CI) for pain intensity for manual therapy versus versus NSAIDs.
Figure 11
Figure 11
Overall and various manual therapies subgroup forest plot of weighted OR (95% CI) for effective rate for manual therapy versus NSAIDs.
Figure 12
Figure 12
Overall and different follow-up times subgroup forest plot of weighted OR (95% CI) for effective rate for manual therapy versus NSAIDs.
Figure 13
Figure 13
Funnel plot of effective rate for manual therapy versus NSAIDs.
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