Exercise, Motor Imagery, and Pain Neuroscience Education for Primary Dysmenorrhea: A Randomized Trial

NCT07196150 | Recruiting

• 2 other identifiers: IKCU-IRB-0260IRB# 0260
• Study Type: interventional
• Target: 51
• Locations: 1 country
• Sites: 1

Brief Summary

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

Conditions

Primary Dysmenorrhea

Keywords

Primary dysmenorrhea; Menstrual pain; Exercise; Motor imagery; Pain education; Cognition

Outcome Measures

Primary Outcomes (3)

• 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.

  Baseline, after 8 weeks of intervention, and 1 month post-intervention follow-up

• 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.

  Baseline and after 8 weeks of intervention (first three days of menstruation)

• 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.

  Baseline, after 8 weeks of intervention, and 1 month post-intervention follow-up

Secondary Outcomes (7)

• Lumbopelvic Motor Control

  Baseline and after 8 weeks of intervention

• Movement Imagery Ability

  Baseline

• Central Sensitization

  Baseline, after 8 weeks of intervention, and 1 month post-intervention follow-up

• Cognitive Flexibility

  Baseline and after 8 weeks of intervention

• Pain Catastrophizing

  Baseline, after 8 weeks of intervention, and 1 month post-intervention follow-up

Study Arms (3)

Exercise Only

EXPERIMENTAL

Participants will complete an 8-week supervised exercise program including lumbopelvic stabilization, stretching, and endurance training, delivered twice per week.

Behavioral: Exercise Program

Exercise + Motor Imagery

EXPERIMENTAL

Participants will complete the same 8-week supervised exercise program. In addition, they will practice kinesthetic motor imagery of the exercises before performing them.

Behavioral: Exercise Program; Behavioral: Exercise plus Motor Imagery Training

Exercise + Pain Neuroscience Education

EXPERIMENTAL

Participants will complete the same 8-week supervised exercise program. In addition, they will receive weekly face-to-face pain neuroscience education sessions supported by home assignments.

Behavioral: Exercise Program; Behavioral: Exercise plus Pain Neuroscience Education

Interventions

Exercise Program BEHAVIORAL

Participants 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 + Motor Imagery; Exercise + Pain Neuroscience Education; Exercise Only

Exercise plus Motor Imagery Training BEHAVIORAL

Participants 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 + Motor Imagery

Exercise plus Pain Neuroscience Education BEHAVIORAL

Participants 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.

Exercise + Pain Neuroscience Education

Eligibility Criteria

• Age: 18 Years - 25 Years
• Gender Eligibility Details: Only individuals who self-identify as female and have biological capacity for menstruation (i.e., women of reproductive age with regular menstrual cycles) are eligible to participate.
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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)
• Nulliparous (no history of pregnancy or childbirth)
• No systemic, metabolic, rheumatologic, or lumbar pathology
• Willingness to participate in the 8-week intervention program and attend follow-up assessments

You may not qualify if:

• 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
• Current use of antidepressants, anxiolytics, or hormonal therapy (e.g., oral contraceptives, intrauterine device)
• Known neurological, psychiatric, or systemic musculoskeletal disorders
• Cognitive impairment or attention deficit that may interfere with participation
• Participation in regular exercise in the last 6 months
• Use of alternative therapies for dysmenorrhea (e.g., acupuncture, massage)

Sponsors & Collaborators

• Muge Dereli: lead

Study Sites (1)

Aydın Adnan Menderes University

Aydin, Efeler, Turkey (Türkiye)

RECRUITING

Related Publications (5)

• Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016 Jul;32(5):332-55. doi: 10.1080/09593985.2016.1194646. Epub 2016 Jun 28.

  PMID: 27351541 BACKGROUND

• Evans S, Dowding C, Olive L, Payne LA, Druitt M, Seidman LC, Skvarc D, Mikocka-Walus A. Pain catastrophizing, but not mental health or social support, is associated with menstrual pain severity in women with dysmenorrhea: A cross-sectional survey. Psychol Health Med. 2022 Jul;27(6):1410-1420. doi: 10.1080/13548506.2021.1948581. Epub 2021 Jun 30.

  PMID: 34190659 BACKGROUND

• Cuenca-Martinez F, Nieves-Gomez A, Millan-Isasi N, Fuentes-Aparicio L, Sempere-Rubio N. Effects of motor imagery and action observation on pelvic floor and related structures in healthy women: A randomized controlled trial. Hum Mov Sci. 2025 Feb;99:103313. doi: 10.1016/j.humov.2024.103313. Epub 2024 Dec 2.

  PMID: 39626586 BACKGROUND

• Kluska J, Malinowska E, Kowalski J. A pilot longitudinal study of decrease in cognitive functions during the most painful day of the period among women with primary dysmenorrhea. Arch Gynecol Obstet. 2025 Feb;311(2):341-346. doi: 10.1007/s00404-024-07617-9. Epub 2024 Jul 4.

  PMID: 38963585 BACKGROUND

• Carroquino-Garcia P, Jimenez-Rejano JJ, Medrano-Sanchez E, de la Casa-Almeida M, Diaz-Mohedo E, Suarez-Serrano C. Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Phys Ther. 2019 Oct 28;99(10):1371-1380. doi: 10.1093/ptj/pzz101.

  PMID: 31665789 BACKGROUND

MeSH Terms

Conditions

Dysmenorrhea; Motor Activity

Interventions

Resistance Training; Exercise

Condition Hierarchy (Ancestors)

Menstruation Disturbances; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pelvic Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Physical Conditioning, Human; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Central Study Contacts

Muge Dereli PhD Candidate in Physiotherapy and Rehabilitation, MSc

CONTACT

+905375069568; mugedereli97@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: PhD Candidate in Physiotherapy and Rehabilitation

Study Record Dates

• First Submitted: September 19, 2025
• First Posted: September 29, 2025
• Study Start: February 25, 2025
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): September 1, 2026
• Last Updated: September 29, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: Data will be available beginning 6 months after study completion and will remain available for 5 years.
• Access Criteria: Researchers who provide a methodologically sound proposal will be able to access the data for academic purposes. Data will be shared via email request to the principal investigator, subject to approval by the study team.

Locations

TU (1)