Vaibhav Kanti,Suraj Kumar,Gowrishankar Potturi,Vandana,Annapurna

1Department of Obstetrics and Gynecology,Uttar Pradesh University of Medical Sciences (UPUMS),Saifai,Etawah 206130,India.2Faculty of Paramedical Sciences,Uttar Pradesh University of Medical Sciences (UPUMS),Saifai,Etawah 206130,India.3Department of Physiotherapy,Faculty of Paramedical Sciences,Uttar Pradesh University of Medical Sciences (UPUMS),Saifai,Etawah 206130,India.4Department of Obstetrics and Gynecology,Uttar Pradesh University of Medical Sciences (UPUMS),Saifai,Etawah 206130,India.5Department of Physiotherapy,Uttar Pradesh University of Medical Sciences (UPUMS),Saifai,Etawah 206130,India.

Abstract Background:Dysmenorrhea is cramping pain in the lower abdomen or pelvis during menstruation.It is the most common gynecologic problem for all ages and racial women.The objective of the study is to find the efficacy of kinesio taping among nulligravida women with dysmenorrhea on pain and functional independence.Methods:A total of 115 patients attending the Obstetrics and Gynecology outpatient department were screened and 66 subjects after satisfying inclusion criteria were recruited and randomly divided into two groups,Group A (control) (n = 32) and Group B (Experimental) (n = 34) by computerized randomization after attaining written consent.Group A received single day dose of pain-relieving medications containing Dicyclominee (10 mg) and Mefenamic acid (250 mg)administered three times a day on the recommendation of a gynecologist.Group B was applied kinesio taping for three days starting from the day of menstruation.Global pain scale (GPS) was used to assess the pain and functional independence,pre-intervention,12 hours,24 hours and,48 hours after the intervention.Results:There was improvement in both the groups in pain and functional independence.But experimental group demonstrated higher GPS scores when compared to Control group,however,the results are not statistically significant at P <0.05.Conclusion:From the results attained,this study concludes that kinesiotaping alleviates pain due to primary dysmenorrhea and improves functional independence.

Keywords:dysmenorrhea;dicyclomine;global pain scale;kinesiotaping;mefenamic acid;pain

Introduction

Dysmenorrhea is cramping pain in the lower abdomen or pelvis during menstruation [1].It is the most common gynecologic problem for all ages and racial women [2].It is observed that about one-third of the women experience moderate to severe pain in their lifetime.Most of them often get absent from school or work and sometimes the social interactions were also reduced than the women who never experienced dysmenorrhea [3,4].Dysmenorrhea can be primary,which does not have any underlying pathology while secondary dysmenorrhea could be due to underlying pathological causes such as endometriosis,adenomyosis,or uterine myoma [5].In young women,primary dysmenorrhea is often observed and experience pelvic or lower abdominal pain which lasts for about 48 h from starting of menstruation [6].Besides pain,some of them experience other symptoms such as diarrhea,constipation,nausea,vomiting,migraine,dizziness and,fatigue [7].Dysmenorrhea can significantly affect the affected women’s quality of life [7,8].Prevalence of dysmenorrhea was reported as 84.2% in India [9].

Most of the women depend on medication to cope with menstrual pain,which may result in drug abuse [9].Some alternative therapies include vitamin supplements,Transcutaneous Electrical Nerve Stimulation (TENS),acupuncture,medicinal plants aromatherapy,reflexology,acupressure,massage therapy,and exercises [10].However,the results of these therapies were short-acting and time-consuming [6].The client needs to visit a health care provider every time for the treatment which is both cost and time consuming.Kinesio taping is a technique that is based on the body’s own natural healing process and used for alleviating pain in any region [11].This study focuses on such taping techniques which is both cost and time-effective in managing menstrual pain easily and conveniently,rather than the use of medications or others therapies.

Hypothesis: the kinesiotaping can reduce pain and improve functional independence on primary dysmenorrhea in nulligravida women over medications

Materials and methods

Ethical approval

The study was approved by institutional ethical committee and a written consent was taken from all subjects before recruitment.(Ethical no: 1056/UPUMS/DEAN(M)/Ethical/2020-21)and the trail is registered with Clinical trials of India (CTRI),reg.no:CTRI/2020/07/026552.

Enrollment&recruitment

This study was conducted at Department of Obstetrics and Gynecology in association with the Physiotherapy department of our university.It is a single-blinded randomized control trial where the subjects were blinded.A total of 115 patients attending the OBG outpatient department were screened and 66 subjects after satisfying inclusion criteria were recruited and randomly divided into two groups,Group A (control) (n = 32) and Group B (Experimental) (n = 34) by computerized randomization.Written informed consent was taken from all the subjects before recruitment.(Figure 1)Females of age group 18 to 30 years (nulligravida),patients willing to participate with a confirmed diagnosis of primary dysmenorrhea,conscious and coherent,and having regular menstrual bleeding are included in the study.Dysmenorrhea with other gynecological conditions,allergy to tape,local unhealed wounds or scars,pain due to other musculoskeletal reasons is excluded from the study.The baseline charecteristics of both Groups is mentioned in Table 1.

Table 1 Baseline demographic Characteristics of Group A and Group B

Figure 1 Consort flow char

Intervention

GROUP A (Control group)–Single day dose of Pain-relieving medications containing Dicyclominee (10 mg) and Mefenamic acid(250 mg) administered three times a day on the recommendation of a gynecologist.

GROUP B (Experimental group)–Kinesio taping is applied for three days starting from the day of menstruation.

Technique of application

The subject is made to lie supine on the treatment couch with proper screening for privacy.Kinesio tape is applied to the abdominal and lumbar area.A piece of Kinesio tape,5 cm in width and 8 cm in length is applied below the umbilicus and stretched down to the pubic line where the pubic hair begins.Another piece of tape 5 cm in width and 10 cm in length is applied horizontally to make a cross shape with the first one with minimal stretch (Figure 2).Then the patient is made to lie prone,a tape of width 5 cm and length 6 cm was applied horizontally on the spinous process of the L5 vertebra(Figure 3).

Figure 2 Technique of application of Kinesio-tape anteriorly

Figure 3 Technique of application of Kinesio-tape posteriorly

Outcome measures

All the demographic characteristics of the subjects were recorded at the time of enrollment and recruitment of subjects.The pain and functional independence was assessed using the Global Pain Scale(GPS).The assessment of GPS was taken pre-intervention at the time of enrollment (t0),12 hours (t1),24 hours (t2) and 48 hours (t3) post application of tape.

GPS is a reliable and valid pain with psychometric integrity of pain.It is a multidimensional scale that addresses the ceiling,flow,and average pain over the past week as well as the current pain.This scale assesses the psychological impact of pain and screens for anxiety,fear,hopelessness and,energy level.

It also explores several specific clinical outcomes including the effect of pain on patient comfort,mood,independence,pattern,quality of sleep,utilization of health care facility,and satisfaction.

The GPS includes 33 items related to the patient’s pain experience on 11 points scale ranging from 0-10.

It has 4 subscales: pain,feelings,clinical outcomes,activities.

Statistical analysis

In this study to analyze the effect of taping on dysmenorrhea in nulligravida women,the baseline demographic characteristics of the subjects in both groups were analyzed statistically for normality by chi-square test.

The GPS scores of pre-test and post-test were expressed in Mean and Standard deviation.The pre-test and post-test scores were analyzed for statistical difference within the group and between the groups by repeated measures Anova at 5% level of significance (P<0.05).

Results

In this study,to analyze the effects of taping on dysmenorrhea,the baseline characteristics of the group analyzed by chi-square test,showed that both the groups are not statistically different,(P>0.05),and passed the normality test (Table 1).There was improvement in both the groups in pain and functional independence.But Experimental group demonstrated higher GPS scores when compared to Control group,however,the results are not statistically significant atP<0.05 (Table 2 and 3),(Figure 4).

Table 2 Repeated measures ANOVA test of between-subjects effects

Table 3 Repeated measures ANOVA test of within-subjects effects

Figure 4 Graph illustrating results within and Group A&B

Discussion

In this study to analyze the effect of Kinesio-taping on dysmenorrhea in nulligravida women when compared to medications,both the groups showed significant improvement in terms of pain and functional independence which was assessed by GPS.Despite the experimental group showed better results than the control group,the results were not statistically significant atP<0.05.In our study even though there is no statistical difference present,we discourage the patients to use medications as they have adverse effects like psychological dependence,habituation,compulsive substance dependence,hallucinations,euphoria,diminished anxiety and,pleasure feelings [12].Apart from these psychological adverse effects,the mefanamic acid and Dicyclominee can also precipitate headaches,nervousness,vomiting,diarrhea,peptic ulcers,hematemesis,skin rashes [13].Patients with utricaria,asthma,known renal or hepatic disease are contraindications for the medications,while the taping could be safely given in all these conditions [13].In the US,generic mefenamic acid has been quoted as $426.90 and branded drug at$571.70.While,in the UK,it is ￡1.66,and branded drug at ￡8.17[14].In India the cost of mefenamic acid and Dicyclominee for 10 tablets is 46 Indian rupees.While the kinesiotape cost in US is $19.20 for “20 × 10” strips,while in UK it is ￡13.45 and in India the generic kinesiotape price at399.In comparison to drug,taping is cost-effective as the net cost per session is lower in taping techniques and hence it is economical.

It has been reported that by previous researchers that 90% of adolescent females experience menstrual pain and 15% feel it as severe and may hinder their life style [15].Kinesio-taping is a non-chemical tape that stimulates the electromagnetic energies of the body which hail naturally and maximizes the natural body’s healing mechanisms [16].From the previous researches,it is understood that taping promotes relaxation of muscles,increases lymphatic and vascular flow,and reduces pain.

Kinesio tape induces constant relaxation and contraction of muscles by stimulating the cutaneous receptors and thus alleviates the pain,which can be explained by neurofacilitation effect,where there is a constant relation between cutaneous afferent stimulation and motor unit firing [17].

Kinesiotaping also alleviates pain by stimulating tactile fibers in the skin through pain gate mechanism.The tape applied at the lower abdomen stimulates the tactile fibers which could inhibit the pain sensitizing action of prostaglandins in the spinal cord [18].

In the research by HanifeDogan et.al,concluded that kinesiotaping alleviates and pain and improves body awareness and quality of life in primary dysmenorrhea[19].Research shreds of evidence are available that kinesiotaping causes vasodilation of arterioles in the pelvic region,thus facilitating the bleeding and excretion of wastes containing prostaglandin that causes contraction [20] .

From the results attained,this study concludes that Kinesio taping alleviates pain due to primary dysmenorrhea and improves functional independence.It is recommended over drug therapies as it is cost-effective,less or no side effects,easy and self administrable,minimal contraindications that suits most of the women and does not require medical professional supervision for application.