The goal of this clinical trial is to find out whether exercise, motor imagery training, and pain neuroscience education can help reduce menstrual pain and improve well-being in young women with primary dysmenorrhea. The study will also look at how these approaches affect menstrual symptoms, movement control, and cognitive flexibility.
The main questions it aims to answer are:
* Does adding motor imagery or pain neuroscience education to an exercise program reduce pain and menstrual symptoms more than exercise alone? * Do these approaches improve movement control, thinking flexibility, and knowledge about pain?
Researchers will compare three groups:
* Exercise only * Exercise plus motor imagery training * Exercise plus pain neuroscience education
Participants will:
* Attend supervised exercise sessions twice a week for 8 weeks * Practice either motor imagery or receive short pain neuroscience education, depending on their group * Complete questionnaires and tests before and after the program, during the first three days of menstruation
Female, aged 18-25 years
Gynecological examination and ultrasound confirming absence of pelvic pathology
History of primary dysmenorrhea for at least 6 months, with pain intensity ≥4 on the Numeric Rating Scale (0-10) during the first 3 days of menstruation
Regular menstrual cycles (21-35 days)
Diagnosis of secondary dysmenorrhea (e.g., endometriosis, pelvic inflammatory disease, uterine fibroids, ovarian cysts)
Current pregnancy or planning to become pregnant during the study period
History of pelvic or abdominal surgery
History of sexually transmitted diseases
Parallel
Exercise Program
BehavioralParticipants will complete an 8-week supervised exercise program, delivered twice per week. The program includes lumbopelvic stabilization, stretching, and endurance training exercises designed to reduce menstrual pain and improve physical function.
Exercise plus Motor Imagery Training
BehavioralParticipants will complete the same 8-week supervised exercise program as the Exercise Only group. In addition, they will practice kinesthetic motor imagery of the prescribed movements prior to performing them, aiming to enhance motor control and pain modulation.
Exercise plus Pain Neuroscience Education
BehavioralParticipants will complete the same 8-week supervised exercise program as the Exercise Only group. In addition, they will receive weekly face-to-face pain neuroscience education sessions focused on pain neurophysiology, supported with home assignments to reinforce learning.
Pain Intensity
Pain intensity will be assessed using an 11-point Numeric Rating Scale (0 = no pain, 10 = worst imaginable pain). Participants will be asked to report their average menstrual pain during the first three days of menstruation.
Pressure Pain Threshold (PPT)
Pressure pain threshold will be measured using a digital algometer (Baseline dolorimeter) applied to the abdominal region and standardized body sites. The minimum pressure (kg/cm²) at which pain is first perceived will be recorded.
Menstrual Symptom Severity
Menstrual symptoms (e.g., cramps, headache, back pain, fatigue, mood changes) will be evaluated using the Menstrual Symptom Questionnaire (MSQ). Total and subscale scores will be calculated.
Lumbopelvic Motor Control
Lumbopelvic motor control will be assessed using the Physioupplies Core Stabilizer Unit, which measures pressure changes during standardized stabilization tasks.
Movement Imagery Ability
Participants' ability to generate and control movement imagery will be assessed using the Movement Imagery Questionnaire. Higher scores indicate better imagery ability.
Central Sensitization
Central sensitization symptoms will be evaluated using the Central Sensitization Inventory (CSI). The total score reflects symptom severity.
Cognitive Flexibility
Cognitive flexibility and inhibitory control will be assessed using the EncephalApp Stroop application. Participants will complete the "off" and "on" runs. Primary variables will be total completion time (seconds) and error count; lower times and fewer errors indicate better performance.
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Muge Dereli
Lead sponsor
Izmir Katip Celebi University
Sponsor institution
