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Impact of Acupressure on Dysmenorrheal Pain among Teen-aged Girls

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 Vol 22, No. 2;Feb 2015

Impact of Acupressure on Dysmenorrheal Pain among

Teen-aged Girls Students
Salwa Roushdy EL-Gendy,
Assistant Professor, Physical Therapy Department, King Abdul Aziz Univ.
Fellow of Physiotherapy, Kasr AL-Aini Hospitals, Cairo Univ.

ABSTRACT
Primary dysmenorrhea is a common gynecological complaint especially for a adolescent girls. Occurring
with its associated symptoms can have an adverse influence on academic attainment, bodily activity, and life
quality. Unfortunately, stress increases the sensitivity and severity of pain, activating sympathetic responses
while inhibiting parasympathetic responses.Treatment of dysmenorrhe includes pharmacological as well as
non-pharmacological approaches .One of the non-pharmacological lines is acupressure .Acupressure is an
early Chinese remedial practice that uses finger pressure to definite meridian points on the body to dismiss
pain. These meridians start at fingertips, connect to the brain, and then connect to the specific organ.
Acupressure may reduce muscle pain and tension, improve blood circulation and enable muscle fibers to
relax. Therefore, this study aimed to identify the effect of acupressure on primary dysmenorrhea. The study
was implemented at five girls secondary schools in Jeddah. From the above mentioned setting 100 students
having a primary dysmenorrhea were selected. Three tools were used. Tool (I) was a specific instructional
questionnaire sheet to assess the students' knowledge and practices regarding their menstrual pain. Tool (II)
was a Visual Analogue pain intensity scale to assess pain intensity. Tool (III) was an instructional guideline
about acupressure which was developed by the researcher; the students were followed for two periods.
Valuation of the efficacy of acupressure was measured for each student by re-assessing pain intensity one
day before menstruation and three successive days after. The result of the present study revealed that
acupressure is one of the effective non-pharmacological approaches to relive menstrual pain, on top of the
symptoms associated with dysmenorrhea.

Key words: acupressure, primary dysmenorrhea

INTRODUCTION

Dysmenorrhea denotes to cramp-like, dull, and throbbing pain that originates from the lower abdomen. The
incidence of dysmenorrhea in adolescents and young women ranges between 40% and 90% and differs with
age, country of residence, and residents mass. Adolescence is the most dynamic period in human
development. During this period, the future health character and cultural profile of an individual are formed;
biological, sexual maturation and psycho-social development take place. One of the most dramatic events
for girls during this period is the onset of the maturation. Menstruation is usually associated with some
minor discomforts. One of these main minor discomforts is dysmenorrhea (1, 2).
Dysmenorrhea is the intermittent lower abdominal pain occurring with menstruation. The pain usually
begins a few hours before bleeding starts, comes to peak intensity within few hours, and fades after 1-3 days
of good menstrual flow (3).
Two forms of dysmenorrheal have been identified, primary and secondary. Primary spasmodic
dysmenorrhea is not caused by any medical problems .On the other hand, secondary dysmenorrhea is caused
by pelvic change as endometriosis, pelvic inflammatory disease, uterine fibroid, or ovarian cyst (3, 4).
Primary dysmenorrhea in adolescent girls is caused by an increase production and release of prostaglandin
(3,4). The uterus contains plenty of smooth muscle stimulator and prior to the onset of period, prostaglandins
increase in concentration. At the end of monthly cycle as the uterine lining starts to break up and shed,
prostaglandins are released in the uterus causing the uterine smooth muscles to contract. These contractions
compress the blood vessels in the uterus so; decreasing uterine blood & oxygen, and causing pain. With the
onset of the menstrual flow, the prostaglandin is discharged into the menstrual flow, which explains why the
associated painful symptoms tend to decline after the first few days of the period (3,4).

Dysmenorrhea may be accompanied with nausea, vomiting, low back pain, felling of fullness, headache,
nervousness and diarrhea or constipation. (1, 2).

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Pharmacological as well as non-pharmacological treatment are used for declining pain. The
pharmacological methods include; analgesics, sedatives, muscle relaxant, nonsteroidal anti-inflammatory
drugs or oral contraceptives .But this drugs have side effects (6,7). While the non-pharmacological
methods include; hot baths, hot drinks, aerobics & complementary methods of pain relief. Complementary
therapy include; acupuncture, herbal therapy & acupressure (8, 9).
Acupressure is an ancient Chinese healing method that applies finger pressure to certain meridian
points on the body to relive pain. These meridians are pathways start at the pressure point on the skin,
connect to the brain, and then connect to the organ associated with the specific meridian (10). The
meridians are discrete channels that flow electrical energy all over the body. They are thought to be part of
a master communication system of life energy, connecting the organs with all sensory, physiological and
emotional aspects of the body (11,12).
Acupressure may reduce muscle pain, tension, improve circulation and release endorphins. It allows
muscle fibers to relax, allows blood to flow more freely & toxins to be released and eliminated. Therefore,
acupressure may reduce menstrual pain reducing pain medication (12). However, some writer claimed
that, there is limited scientific evidence about the effectiveness of acupressure on relief of dysmenorrhea
(13).
So far, with the rising interest in complementary therapies, where a natural non-invasive approaches
are needed to aid in relieving pain during reproductive period. Complementary therapies come
increasingly popular with health care consumers in recent years. As girls seek information and attempt to
make decisions about this therapy, they often turn to physiotherapists and ask their opinion (14,15).
Providing accurate information about complementary therapy assist in training of acupressure. From
this prospective, it is recognized that ability to perform and use these techniques can be greatly enhanced
when they are integrated into the context of professional physiotherapist education .So, this study in turn
pave the way to introduce acupressure in official physiotherapy practice by testing the effectiveness of
acupressure on relieving of dysmenorrheal (15,16).

AIM OF THE STUDY

The aim of this study was to identify the effect of acupressure on dysmenorrhea among teen-aged girls.

SUBJECTS, MATERIAL AND METHODS

This study is an experimental study design, where the effect of an independent variable (acupressure)
on an independent variable (pain intensity) was measured.

Setting: The study was carried out at five girls' secondary schools in Jeddah.
Subjects: A suitable sample of 100 Saudi girl students, suffering from primary dysmenorrhea in various
degree, having regular menstruation and free from any medical disease participated in the study.
Tools:
Three tools were used in the study
1- A specific structured questionnaire sheet was developed by the researcher to collect biosocial data from
the students as well as information and practices regarding dysmenorrhea.
2- Visual Analogue pain intensity Scale (VAS) ; It is a self- reported 10 cm straight line which represents
the pain intensity, the two opposite ends representing no pain to pain as bad as it could be in between these
two phrases , words like mild pain , moderate pain , severe pain , very severe pain are assigned to each
two cm distance respectively. It was used to measure menstrual pain intensity before and after one-two
consecutive menstrual cycle of application of acupressure.
3- Instructional guidelines about self- application of acupressure (handouts);
It was developed by the researcher in simple language. It included; acupressure points (meridians),
technique and specific instructions that should be taken before and after acupressure.

METHODS
An approval was obtained from five girls' secondary schools in Jeddah.
-Structured questionnaire sheet and the hand out were developed.
-Written consents were taken from the students for their participation in the study after the explanation of
the aim and confidentiality of obtained data.
-During the enrollment session, the students were individually interviewed to collect the biosocial data as

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well as information and practices about dysmenorrhea, student privacy was considered.
-The students were given a AVS and handout about acupressure with explanation for its content
(acupressure points and technique), as well as how to use AVS. Then the students were asked to self-
demonstrate the acupressure technique under the supervision of the researcher to be sure that the students
will perform it safely and accurately during the next two menstrual cycle.
-The students were asked to register the pain intensity one day before the onset of menstruation and three
consecutive days after application of acupressure using VAS for two consecutive menstrual cycles. The
researcher instructed the students to stop the use of any pain relieve measures at this time except
acupressure
-Students were met two times. In the first meeting, the students were seen for demonstration of
acupressure application and registering pain intensity pain using AVS. They also asked about the
symptoms associated with dysmenorrhea.
-In the second meeting the researcher collects the VAS from the students to compare the degree of pain
before and after the application of acupressure.
-Telephone calls & What's App messaging were used as a direct method of contact with the students to
ask about any problem related to application of acupressure or VAS. Data were collected from January
2014 –June 2014.
Statistical analysis:
Statistical analysis was done using statistical package for social sciences
(SPSS, version 16 software).
The statistical tests were used as follow:
1- Number and percent of each category.
2- Chi square test was used to analyze the categorized data.
The 5% was chosen as the cut level of significance.

RESULTS
Table (1) shows the general characteristics of the studied student .It has been found that, 70% of the
students aged from 14- 16 years. The majority of the student’s fathers were educated 30% & 34% for
secondary school and university education respectively. Likewise, 24% and 36% of students' mother were
secondary school & university education respectively. Regarding parents' education the majority of the
students' father (92%) were employee, while, 90% of the students' mothers were house wives.

Table 1: Students' general characteristics

General Characteristic No (100) %

Student's Age
- 14 year
- 15-16 years 30 30
70 70
Father 's Education
- Illiterate / read and write 36 36
- < secondary school 30 30
- Secondary school or university education 34 34

Father' Employment
- Employee 92 92
- Private work 8 8

Mother' Education
- Illiterate / read and write
- < secondary school 38 38
- Secondary school or university education 24 24
36 36
Mother's Employment
- Working 10 10
- Housewives 90 90

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Table (2) displays different factors affecting severity of dysmenorrhea among adolescent Saudi girls. It
revealed the percent of these factors according to their priorities as follows: null parity 100%, stress 52%,
physical activity 40% cold drink 34%, overweight 20% and eating a spicy food 10%.

Table 2: Factors associated with severity of dysmenorrhea.

Factors No (100) %
Null parity 100 100
Stress 52 52
Physical activity 40 40
Cold drink 34 34
Over weight 20 20
Spicy food 10 10

Table (3) expresses different methods used by Saudi female students to relief dysmenorrhea. Before
implementation of acupressure, it was obvious that, the most common pharmacological methods used to
relief menstrual pain were analgesia, sedatives and muscle relaxant (48% and 20% respectively). On the
other hand, the most common non-pharmacological methods used to relief menstrual pain were, herbals,
hot drinks & exercises (50%, 48%, and 20% respectively).

Table (3): Methods used to relief dysmenorrhea before acupressure

Methods Before Acupressure

No. %
Pharmacological Methods:

Analgesics / Sedatives 48 48.0

Muscle relaxants 20 20.0
NSAIDS (Nonsteroidal anti-inflammatory drugs) 8 8.0
Oral contraceptives 0 0.0
Non-pharmacological Methods:
Hot drinks 48 48.0
Hot bath 8 8.0
Exercises 20 20.0
Complementary therapies
- Herbal remedy 50 50.0
- Acupressure 0 0.0

Table (4) Indicates a significant decrease in the occurrence of menstrual pain after one and two months of
application of acupressure (x² =35.2 & 38.2) respectively. It also represents a significant improvement in
pain location after the application (x²= 36.2 & 36.8). Forty students (40%) out of 100 had no pain after
two months of acupressure. In addition, there is a significant decrease in the pain severity (x² =57.3 &
69.9 respectively).

Table 4: Occurrence, location and severity of dysmenorrhea before and after acupressure

Occurrence , Location and Before Acupressure After one Month After two Months
Severity of Dysmenorrhea (N= 100) (N = 100) (N = 100)

No % No % No %

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Occurrence of pain :
-One day before menstruation 8 8.0 0 0.0 4 4.0
-1st day of menstruation 100 100 6 12.0 8 8.0
-2nd day of menstruation 34 34.0 22 22.0 14 14.0
-3rd day of menstruation 26 26.0 6 6.0 0 0.0
da
X² , P 35.2, 38.2,
0.0001* 0.00001*
Location of pain ;
-Abdomen 20 20.00 28 28.00 30 30.00
-Abdomen and back 32 32.00 18 18.00 20 20.00
-Abdomen ,back and thigh 30 30.00 12 12.00 10 10.00
-Abdomen and thigh 18 18.00 6 6.00 0 0.00
-No pain 0 0.00 36 36.00 40 40.00

X² , P 36.2, 36.8,
0.0001* 0.0001*
Severity of pain :
-No pain 0 0.00 36 36.00 40 40.00
-Mild 6 6.00 36 36.00 46 46.00
-Moderate 32 32.00 24 24.00 14 14.00
-Severe & very severe 62 62.00 4 4.00 0 0.00

X² , P 57.2, 69.9,
0.00001* 0.00001*

Table (5) displays that dysmenorrhea may be associated with physical, social and psychological
symptoms before the application of acupressure, the most common symptoms were as follows 60% for
backaches, 42% for insomnia, 36% for nausea, 34% for nervousness, 30% for school absence. A
significantly decrease occurred after one and two months of acupressure (x² =12.98 & 9.86) for physical
symptoms and (x²=21.65, 32.3) for psychological symptoms and (x²= 4.21 & 8.98) for social problem
respectively .

Table (5): Symptoms associated with dysmenorrhea before and after acupressure

Before Acupressure After 1 Month After 2 Months

(n=100)
Symptoms (n=100) (n=100)

NO. % NO. % NO. %

Physical
-Back aches 60 60 20 20 20 20
-Nausea 36 36 18 18 12 12
-Headache 20 20 10 10 12 12
-Vomiting 14 14 6 6 0.0 0.0
-Diarrhea 10 10 4 4 4 4

x² , p 12.98 , 0.002* 9.86 , 0.006*

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Psychological
-Insomnia 42 42 8 8 12 12
-Nervousness 34 34 12 12 6 6
-Loss of concentration 10 10 4 4 4 4

x² , P 21.65, 0.0001* 32.3, 0.0001*

Social
School absence 30 30 12 12 6 6

x² , P 4.21, 0.0021* 8.98, 0.0001*

DISCUSSION

Dysmenorrhea is a common problem among adolescents and is a leading cause of recurrent school
absence (2,8). The results of this study clarifies that, acupressure was effective for relieving
dysmenorrhea, decreasing occurrence, severity and location of pain and pain medication used (table 4).
This finding was congruent with many authors who reported that acupressure is an effective and safe non-
pharmacological strategy for reliving of primary dysmenorrhea. They also added that, menstrual pain
intensity was declined by 50% in adolescents after implementation of acupressure (17, 18, and 19).

The result of the present study revealed that, the common physical, social risk factors that may affect
severity of dysmenorrhea were null Parity , stress , cold drinks , physical activity and overweight (table 2).
In accordance with M. Nohara 2011, who mentioned that, there is association between stress &
overweight and severity of menstrual pain (17). Other researcher stated that, reducing physical activity has
been associated with prevalence of pain. (18) This result may be due to the fact that the entire study
subject was a null Para.

The findings of the present study demonstrates that, about half of the study subjects (48%) used
analgesics and sedatives, herbal (50%) and or hot drinks before the implementation of acupressure. This
result was in line with M. I. Ortiz 2010, who mentioned that, the coping methods with menstrual cramps
include using nonsteroidal anti-inflammatory or sedative & analgesic drugs as an initial therapy. While,
other women use of herbal remedy and or rest (22). This may be due to the fact that, the cultural beliefs
can affect the mode of coping with menstrual cramps.

It was noted that acupressure had an obvious effect to decline many symptoms associated with
dysmenorrhea such as back pain, insomnia, nausea, nervousness and school absence. This result was
congruent with the study of N. Mirbagher, 2011 who declared that menstrual cramps might be associated
with nausea, low backache, leg aches, feeling of fullness, headache and diarrhea or constipation.
There is a significant decrease in the symptoms associated with dysmenorrhea after the application of
acupressure. This result was supported by many researchers (23,24) who revealed that acupressure was
effective in lessening pain and distressing symptoms associated with dysmenorrhea.

CONCLUSION
Agreeing with the results of this study, it can be concluded that, acupressure is one of the effective non-
pharmacological methods for reducing pain intensity, occurrence, location and pain medications used.
The results of this study also indicated that acupressure is operative in reducing the symptoms
associated with dysmenorrhea.

RECOMMENDATIONS
In accordance with the findings of the present study, the following recommendations are proposed;
1- Educational program should be planned and implemented to orient young girls about acupressure

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effects, and way of application.

2- Implementing an extensive education program for therapists about acupressure & complementary
therapy.
3- Establishing adolescent friendly clinics at preparatory & secondary schools to enable female students
easily seek help regarding menstrual pain.
4- Providing sufficient texts, brochures and magazines related to menstruation and how to cope with it, at
preparatory & secondary schools and universities.
5- Pediatric hospital policies should encourage the concept of acupressure as a complementary therapy.

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