Pain Neuroscience Education Added to Exercise for Primary Dysmenorrhea

Activity Interference Due to Menstrual Pain

Interference of menstrual pain with daily activities was assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no interference) to 10 (maximum interference), with higher scores indicating greater interference.

Time frame: Baseline, first menstrual cycle following the 6-week intervention (T1), and menstrual cycle closest to 3 months post-intervention

Duration of Menstrual Pain

Interference of menstrual pain with daily activities was assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no interference) to 10 (maximum interference), with higher scores indicating greater interference.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention

Analgesic Use Occasions

The number of occasions on which analgesic medication was used for menstrual pain was recorded during each assessment cycle.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention

Any Analgesic Use

Whether the participant used any analgesic medication for menstrual pain during the assessment cycle was recorded as a dichotomous outcome.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention

School or Work Absence Due to Menstrual Pain

The number of days of absence from school or work attributable to menstrual pain was recorded during each assessment cycle. Higher values indicate greater absenteeism.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention

Pain Catastrophizing Scale Score

Pain-related catastrophic thinking was assessed using the Pain Catastrophizing Scale (PCS), a 13-item self-report measure. Each item is scored from 0 to 4, yielding a total score ranging from 0 to 52. Higher scores indicate greater pain catastrophizing and therefore a worse outcome.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention

Pressure Pain Threshold (PPT)

Pressure pain threshold was assessed using a Commander Echo Algometer (JTECH Medical, Midvale, UT, USA) equipped with a 1 cm² probe at standardized suprapubic, lumbopelvic, and tibialis anterior sites. Higher values indicate lower mechanical pain sensitivity.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention; assessments were performed during both painful and pain-free phases of the menstrual cycle.

Pelvic Floor Mobility Assessed by Transperineal Ultrasound Description:

Pelvic floor mobility was assessed using two-dimensional transperineal ultrasound. Outcomes included cranial excursion during voluntary pelvic floor contraction, caudal excursion during bearing down, and return-to-rest time following the maneuver. Each maneuver was performed three times, and the mean value was used for analysis.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention; assessments were performed during both painful and pain-free phases of the menstrual cycle.

Conditioned Pain Modulation

onditioned pain modulation was assessed using tibialis anterior pressure pain threshold as the test stimulus and contralateral hand immersion in cold water (10 ± 1 °C, maximum 120 seconds) as the conditioning stimulus. The CPM response was calculated from the change in pressure pain threshold during conditioning.

Time frame: Baseline, first menstrual cycle following completion of the 6-week intervention, and menstrual cycle closest to 3 months post-intervention; assessments were performed during both painful and pain-free phases of the menstrual cycle.