NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN THE ALLEVIATION OF PRIMARY DYSMENORRHOEIC PAIN

The cramping, and often debilitating, pain which women of child-bearing age experience in
\nthe lower abdomen just before, or during, menstruation, in the absence of any pelvic
\npathology, is called primary dysmenorrhoea. The aetiology of dysmenorrhoea is not fully
\nunderstood and the condition is often poorly treated. The aim of my thesis is to contribute
\nknowledge to the assessment and treatment of dysmenorrhoea, as well as objective
\nmeasurement of the impact of dysmenorrhoea on physical activity and functional performance.
\nI completed three separate studies, on three different groups of healthy young women with a
\nhistory of moderate-to-severe primary dysmenorrhoea. I used the McGill Pain Questionnaire
\n(MPQ) and the visual analogue scale (VAS), as indices of pain intensity, to assess the efficacy
\nof three cycloxygenase (COX) inhibitors, covering a spectrum of COX-2 selectivity, in the
\ntreatment of dysmenorrhoea. The pain response index (PRI) and present pain index (PPI),
\ncalculated from the MPQ, and the VAS, were highly correlated as measures of intensity of
\ndysmenorrhoeic pain. The COX-2 specific inhibitor rofecoxib, and the non-selective COX
\ninhibitor diclofenac potassium, significantly decreased the duration of dysmenorrhoeic pain,
\ncompared to placebo and compared to meloxicam, a COX-2 selective inhibitor, and were
\nequally effective in relieving menstrual pain.
\nWomen with dysmenorrhoea subjectively report decreased physical activity, but no studies have attempted to quantify the decrease in exercise performance, or functional ability resulting
\nfrom dysmenorrhoea, in a standardized laboratory protocol when women perform structured
\nphysical activity. Furthermore, no method or tool has been described which measures the the
\neffect of dysmenorrhoea on the activity of daily life. I assessed whether an activity data logger
\n(actigraphy), worn on the hip, was able to detect, and quantify, pain-reduced physical activity
\nlevels in women with dysmenorrhoea going about their daily lives. In the laboratory protocol I
\nshowed that moderate-to-severe dysmenorrhoea, but not the act of menstruation without pain,
\ndecreased the women’s ability to bend over and stretch upwards, and to perform exercise that
\nrequired the use of their lower limb muscles. Administration of diclofenac potassium
\nattenuated dysmenorrhoea and restored exercise performance and functional ability to levels
\nattained when the women were in a pain-free phase of the menstrual cycle. I showed that
\nactivity data loggers, worn on the hip of each woman, were able to detect and quantify painreduced
\nactivity of daily life. Moderate-to-severe menstrual pain, but not menstruation itself,
\ndecreased the women’s physical activity, as measured by the data loggers, to about two-thirds
\nof the activity measured when they were in a pain-free phase of the menstrual cycle In conclusion, I have added further knowledge to the assessment and treatment of
\ndysmenorrhoea. The VAS and the MPQ, incorporating the PRI and PPI, are interchangeable
\nindices of intensity of dysmenorrhoea and, depending on the educational status of the cohort,
\nany one of the indices is suitable for assessment of intensity of pain. Rofecoxib and diclofenac
\npotassium, two cycloxygenase inhibitors with differing COX-2 specificity, are excellent
\npharmacological therapies for the treatment of dysmenorrhoea. Objective assessment of
\nphysical activity, via activity data loggers, is a potentially useful tool to investigate the effects
\nof dysmenorrhoea on structured physical activity and the activity of daily life, and for
\nmeasuring pain-related debilitation and its management.

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