Dor na dismenorreia primária: caracterização sintomática e efeito da tens e do exercício físico

Introduction: Primary dysmenorrhea (PD) is defined as colic in the lower abdomen with no pelvic disease. Despite its high incidence, PD is poorly studied, so that its etiology, risk factors and effective forms of treatment are still not well known. Therefore, the objectives of the current study were 1) to present the main pain characteristics, psycho-emotional elements, menstrual and social profile of patients with PD, verifying possible relationships between these data; 2) study the benefits of short- and long-term treatment with TENS; 3) analyze the effects of the association between TENS and physical exercise. Methods: This is a research with three experimental phases, the first is a cross-sectional observational study and the second a placebo-controlled randomized clinical trial. 37 women were included. Outcomes analyzed in all phases were: pain intensity at rest, during abdominal contraction and during mechanical pressure on the abdomen and physical fatigue (11-point numerical scale), pressure pain threshold (algometry), central sensitization (temporal summation) , conditioned pain modulation (conditioned pain modulation), pain catastrophizing (pain catastrophizing questionnaire), pain characterization (McGill pain questionnaire), motor performance (6-minute walk test), motivation, international questionnaire of physical activity (level of physical activity), which (motivation inventory for regular physical activity), quality of life (quality of life issues). Demographic, anthropometric and menstruation characterization data were also collected. In the second experimental phase, the intervention consisted of three months of application only of TENS (active or placebo), for three menstrual cycles, in the first two days of menstruation, while in the third phase, three months of physical exercises were applied. Core Training type and High Intensity Interval Training, twice a week. Results: In the first phase of the study, the analysis of sample characteristics showed a relationship between quality of life and age (r=0.537; p=0.035; β=1.610); quality of life and catastrophizing (r=0.532; p=0.001; β=1.737); functional mobility and age (r=0.375; p=0.027; β=-4.947); mobility and pain intensity in movement (r=0.334; p=0.050; β=-8.030); bleeding flow and age at menarche (OR=70.25; β=20.370; 95% CI 14.08-35.03); duration of menstruation and bleeding flow (OR=1.25; β=-20.493; CI=95% 2.17-7.27). In the second phase, we observed that, compared to the placebo group, active TENS reduced pain intensity at rest on days 3 (p=0.036; d=0.34; CI=95% -0.31-1.00), 4 (p=0.014; d=0.40; 95% CI -0.25-1.06) and 5 (p=0.044; d=0.33; 95% CI -0.32-0.98) of treatment; reduction in the intensity of pain in movement on days 3 (p=0.04; d=0.34; CI=95% -0.31-0.99), 4 (p=0.02; d=0.36 , CI=95% -0.29-1.01) and 5 (p=0.03; d=0.36; CI=95% -0.29-1.01); reduction in pain intensity during mechanical pressure on day 6 (p=0.019; d= 0.39; CI=95% -0.27-1.04); increased quality of life (p=0.001; d=0.55; CI=95% -0.11-1.21) and decreased fatigue (p=0.017; d=0.83; CI=95% 0. 16-1.50). In the third experimental phase, there was no difference between groups in any of the variables. Conclusion: TENS reduced pain intensity at rest, movement and during pressure on the abdomen, in addition to improving fatigue, quality of life and pain characterization. When previously applied, active TENS was not effective in enhancing the effect of physical exercise, denoting that the phenomenon of central desensitization did not occur.

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