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Is heat application as good as pain killers when suffering from dysmenorrhea ?

Three Part Question

In [woman with primary dysmenorrhea] is [heat application] a comparable alternative to [pain killers] at [decreasing pain]?

Clinical Scenario

A 16 year old girl presents to her general practitioner, monthly she suffers from dysmenorrhea. Her dysmenorrhea is often associated with vomiting and therefore her mother does want to know if a non-pharmaceutical therapy can reduce the pain as well. You wonder if applied heat is as effective in providing menstrual pain relief and reduction of abdominal cramping as pain killers.

Search Strategy

Medline 1966-1 April 2012 using the Pubmed interface: (\"Dysmenorrhea\" [Mesh] OR (\"Menstruation\"[Mesh] AND \"Pain\"[Mesh])) AND (\"Hot Temperature\"[Mesh] OR \"Heating\"[Mesh] OR Heat* OR Warm* OR \"Rewarming\"[Mesh])
LIMIT English and Humans

Embase and Medline 1947-1 April 2012 via the Embase.com interface: (\'dysmenorrhea\'/exp OR (\'menstruation\'/exp AND \'pain\'/exp)) AND (\'heat\'/exp OR \'heating\'/exp OR \'warming\'/exp OR Heat* OR Warm*)
LIMIT English and Humans

The Cochrane Library using the Wiley interface: (MeSH descriptor \"Menstruation\" explode all trees OR MeSH descriptor \"Dysmenorrhea\" explode all trees) AND (MeSH descriptor \"Hot Temperature\" explode all trees OR \"heat*\" OR \"warm\")

Search Outcome

Altogether 114 papers were found of which two were selected as providing the best evidence. The results of this paper are shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Akin M et al.
2001
USA
79 woman with primary dysmenorrhea who received over 2 days (12h/day) a) an abdominal heated patch or b) an oral medication (ibuprofen 200mg) c) double placebo (patch and tablets) Randomised controlled trial (level of evidence 1b) Mean pain relief during 2 days (score 0-5)a) vs c) 3.27 vs 1.95 (p<0.001); b) vs c) 3.07 vs 1.95Small study population.
Akin M et al.
2004
USA
344 healthy premenopausal adult woman with primary dysmenorrhea who received over 8 hours a) an abdominal heat wrap or b) oral medication(acetaminophen-1000 mg) Randomised controlled trial (level of evidence 1b)Mean pain relief day 1 (0-8h) (score 0-5)(2.48 0.10 vs 2.17 0.10; p= 0.015)
Mean abdominal muscle tightness/cramping day 1 (0-8h) (0-100)(40.4 1.64 vs 44.5 1.67; p=0.040)

Comment(s)

Evidence from one study showed that heat application as well as the use of pain killers resulted in a comparable statistically significantly higher pain relief during menstrual pain, when compared to placebo treatment (Akin M, 2001). Evidence from another study showed that continuous topical heat application resulted in a statistically significantly higher pain relief and lower muscle tightness/cramping during menstrual pain, when compared to pain killers (Akin M, 2004).

Clinical Bottom Line

Heat application is a good alternative to pain killers in case of dysmenorrheal pain.

References

  1. Akin MD, Weingand KW, Hengehold DA, Goodale MB, Hinkle RT, Smith RP. Continuous low-level topical heat in the treatment of dysmenorrhea. Obstet Gynecol. 2001 Mar;97(3):343-9.
  2. Akin M, Price W, Rodriguez G Jr, Erasala G, Hurley G, Smith RP. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. J Reprod Med. 2004 Sep;49(9):739-45.