| BackgroundThe epidemiological investigation on primary dysmenorrhea at home and abroad shows that primary dysmenorrhea seriously affects women’s work,study and quality of life,and leads to the decrease of women’s work and learning efficiency during menstruation.The incidence of primary dysmenorrhea is higher in foreign countries than in China.Moreover,although dysmenorrhea is so serious that women are often unable to participate in daily physical activities,most women still think it is inevitable.They do not seek medical help,nor do they usually use medication.Therefore,how to alleviate the pain of primary dysmenorrhea patients and improve their quality of life has become one of the important topics in the medical field.At present,the treatment status of primary dysmenorrhea is not very ideal,and traditional Chinese massage therapy has been playing an important role in the treatment of tendons and pains.Therefore,this study attempts to analyze the clinical treatment and medical research status of primary dysmenorrhea,and discuss the efficacy of massage in the treatment of primary dysmenorrhea,in order to provide new ideas and methods for the treatment of primary dysmenorrhea.ObjectiveBy reviewing and analyzing the epidemiological study of primary dysmenorrhea,the pathogenesis of traditional Chinese and Western medicine and the status of related treatment methods,in addition,through evidence-based medicine research methods,to evaluate the effectiveness and safety of massage for primary dysmenorrhea,and to explore the advantages and disadvantages between massage and other commonly used therapies for primary dysmenorrhea.MethodLiterature review:Based on the theories of traditional Chinese medicine and Western medicine,this paper summarizes the etiology,pathogenesis,treatment principles and methods of primary dysmenorrhea,as well as the pathogenesis and treatment methods of Western medicine.The research status of massage in the treatment of primary dysmenorrhea was analyzed.Systematic review:Search Cochrane Library,Pubmed,Web of Science,CNKI,WanFang,SinoMed Databases and other databases to find randomized controlled trials on massage treatment of primary dysmenorrhea.Search time is from the establishment of databases to March 2019.Two researchers independently and repeatedly screened the literature according to inclusion criteria and exclusion criteria,and extracted data from the literature that met the inclusion criteria.Two researchers used Cochrane Reviewer Handbook 5.1.0 bias risk assessment tool to evaluate RCT bias risk.Qualitative analysis and quantitative analysis are used in data analysis,and quantitative analysis is completed by Revman 5.3 software and Meta analysis.GRADEpro GDT is used to classify the quality of evidence.ResultLiterature review:Through the method of review,we know that the incidence of primary dysmenorrhea in women is high,mainly young women,which seriously affects women’s study,work and life,but the current status of treatment is not ideal.The main point of treatment of primary dysmenorrhea in western medicine is to improve symptoms,mainly aiming at the symptoms of female abdominal pain,such as spasmolysis and pain relief.At present,the clinical treatment of primary dysmenorrhea is mainly divided into three aspects:routine drug treatment,surgical treatment and physical therapy.Non-steroidal anti-inflammatory drugs are mainly used in drug treatment,but they are easy to cause adverse reactions such as gastrointestinal tract;surgical treatment is considered only when drug treatment is ineffective,and surgical treatment is mostly applied to secondary dysmenorrhea patients.Therefore,patients with ineffective drug treatment should again exclude organic lesions;other auxiliary treatment methods include exercise,transcutaneous nerve electrical stimulation,behavioral intervention,local hyperthermia and drinking.Chinese medicine,acupuncture,massage and other treatment of primary dysmenorrhea has a good effect,and less adverse reactions,massage is safe,simple and effective,can alleviate the pain of patients with primary dysmenorrhea,but the evidence is weak.Systematic evaluation:A total of 33 randomized controlled trials(2353 subjects)were included in the system evaluation.The main results are as follows:Compared with the western medicine group,the massage group also had three menstrual cycles.The effective rate of the massage group could be increased by 21%(RR 1.21,95%Cl 1.13 to 1.30,P<0.00001;moderate),and could reduce the VAS score(SMD-1.40,95%CI-2.61 to-0.20,P = 0.02;low quality),and also improve the NRS score(MD-2.12,95%CI-2.73 to-1.51,P<0.00001).After treatment for one,two,three menstrual cycles and follow-up for three menstrual cycles,massage could improve dysmenorrhea symptom scores(MD-0.99,95%CI-1.38 to-0.60,P<0.00001;MD-4.90,95%CI-5.57 to-4.23,P<0.00001;MD-2.10,95%CI-2.47 to-1.73,P<0.00001;MD-9.59,95%CI-9.91 to-9.27,P<0.00001).Compared with traditional Chinese medicine or Chinese patent medicine,massage has a more prominent effect in treating 3 menstrual cycles(RR 1.17,95%CI 1.10 to 1.26,P<0.00001;moderate),VAS score improved significantly(SMD-0.71,95%CI-1.03 to-0.39,P<0.0001;low quality),and dysmenorrhea symptom score in massage group was more significant(MD-3.03,95%CI-3.49 to-2.57,P<0.00001;moderate),CMSS continued.The improvement of interval and severity of massage group was significant(MD-3.20,95%CI-5.46 to 0.94,P=0.006;MD-2.65,95%CI-4.44 to 0.86,P=0.004).Compared with acupuncture,the effect of massage on three menstrual cycles was more obvious(RR 1.15,95%CI 1.02 to 1.29,P=0.02,low quality).During one and two menstrual cycles,the duration and severity of CMSS were significantly improved in massage group(MD-11.00,95%CI-14.21 to-7.79,P<0.00001;MD-13,66,95%CI-16.59 to-10.73,P<0.00001).MD-6.39,95%CI-8.00 to-4.78,P<0.00001;MD-7.80,95%CI-9.48 to-6.12,P<0.00001).There are no reports about adverse reactions of massage in the studies included in this paper.However,due to the low quality of the studies included in this paper and the small sample size of a single index at a certain stage of treatment,the evaluation criteria of the efficacy of each study are inconsistent and the measurement units are not uniform,the conclusion is weak.Conclusion1.Massage is effective for primary dysmenorrhea.It can improve the VAS score,dysmenorrhea symptom score,COX dysmenorrhea symptom score and NRS score of primary dysmenorrhea patients,so as to alleviate the pain of patients.And there are no reports of adverse reactions to massage therapy.2.Although massage has some advantages in the treatment of primary dysmenorrhea,the quality of most evidence is not high.The main reasons are small sample size,small number of related tests,unreasonable and imprecise design of test scheme,non-standard test report,inconsistent evaluation criteria of curative effect,and different measurement units. |
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