1. The qualitative arm of a randomized controlled study
ARCIM INSTITUTE ACADEMIC RESEARCH IN COMPLEMENTARY AND INTEGRATIVE MEDICINE
The effects of Rhythmical Massage Therapy and Heart rate variability-biofeedback on Dysmenorrhea.
The qualitative arm of a randomized controlled study
A. Böning1, A. Karutz1, J. Vagedes1,2, D.D. Martin1, B. Berger3
1Tübingen University Children´s Hospital, 2ARCIM-Institute, Filderstadt, 3Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University
Methods
We conducted this study as a randomized controlled trial. The patients were randomly allocated to one of the two intervention groups or the control group. Of a total of 60 women who were part of the randomized trial, we selected 2 patients from the control group, and 6 patients of each of the intervention groups for the qualitative part of this study. They were matched for heterogeneity of age, number of pregnancies and improvement of symptoms in order to represent different kinds of influencing factors.
The women drew their pain before and after the three-month intervention into a body silhouette to facilitate access to their own body perception. With the aid of these drawings, half-structured interviews were conducted after the intervention, in which the patients described their perception of pain and their individual effects of the treatment. All interviews were audio-recorded and analyzed with qualitative methods (Content analysis) using the software MAXQDA.
Background
Strong period pains can induce severe limitations to daily life. This study investigated Rhythmical Massage Therapy and Heart rate variability-biofeedback (HRV) as new alternatives to NSAIDs and oral contraceptives.
Aim
The purpose of the study was to describe the effects of dysmenorrhea and the treatment on the daily life of the affected women. Based on this, various changes throughout the treatment were studied. Special attention was paid to pain intensity, body image, perception and distribution of body heat and cognitive self-examination of their complaints as well as the multitude of effects achieved through the treatment.
ML14: Painting
before rhythmical
massage therapy
Results
Effect of dysmenorrhea on the women
Dysmenorrhea entails different kinds of symptoms and complaints for every woman.
“Here in the front are these cramps in my underbelly radiating into my back.” (B-DS02: 2)
“When it starts, the pain builds up and it cramps more and more, the point can come, that the pain is so strong, that I cannot move anymore, my cycle collapses and I feel like vomiting, I sweat, I am cold, I shake and I cannot speak.” (K-ML14:2)
Changes through therapy
The results show a very heterogeneous picture of different therapy effects. For some women it was relaxing, without an effect on their complaints, other women described a change and benefit on the physical, emotional and/or social level:
Pain:
The intensity of pain, which was most frequently described in the underbelly, can be reduced by the interventions.
„From cycle to cycle it got increasingly better. It is amazing, now, at the end of the study, I don´t have to take any pain medication.“ (M-DW11: 2)
Limitations in daily life:
The remarkable limitation in daily life and the pain medication can be reduced. The women feel more free and relaxed.
„I still feel that there is something, but I am not so restricted any more. I can actually do everything normally, without taking medication.“ (M-RS15: 12)
Body warmth:
The intervention can improve the dissemination and perception of the body warmth.
“… I had really warm feet, not only because of all the socks and wool, but properly from the inside.“ (M-FP06: 17)
Emotional and social effects:
In some cases, the intervention brought up thoughts of which the patients had not been aware of. The therapy gives them the opportunity to work on themself on an emotional level.
„…there was this experience, that I had during the relaxing time after a massage, a spiritual experience, where an angel gave me a gift into my hands, regarding the subject healing… and of course there is this question… how I can integrate this impulse in my life.“ (M-ML14:36)
Body perception:
The intervention can enable the women to sense their body in a more differentiated way. They can thereby understand the correlations between their symptoms and their cycle and achieve higher self-acceptance.
„Through the massage… earlier the awareness of my body stopped here (points to hip), I didn´t really feel my legs. Through the massage, now I can feel a lot more of my body and also the boundaries of my body are more present to me.“ (M-FP06:10) 
ML14: Painting
after rhythmical
massage therapy
Conclusions
The stress of the affected women trough the period pain needs to be taken more seriously than it often is. Treatments to improve body awareness and autonomic regulation can be helpful. The analysis also shows the importance of the emotional condition, which can have a strong influence and should be included in the therapy to ensure a better efficacy of the treatment.
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