Graded Motor Imagery for Primary Dysmenorrhea

NCT07618832 | Recruiting DMC

• 1 other identifier: UHS/DUGS-26/1959
• Study Type: interventional
• Target: 81
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial is to learn if graded motor imagery can reduce pain sensitivity and period pain in women with primary dysmenorrhea (painful periods with no medical cause). The main questions it aims to answer are:

1. 1.Is there a decrease in pressure pain threshold (increased pain sensitivity) with graded motor imagery?
2. 2.Is the intensity of menstrual pain reduced by graded motor imagery?
3. 3.Is GMI helpful to reduce menstrual symptoms and pain catastrophizing (negative thinking about pain)?
4. 4.Take part in a 6-week graded motor imagery program, sham program, or no intervention control.
5. 5.Do laterality recognition, motor imagery, and mirror therapy exercises in the graded motor imagery group.
6. 6.Complete pain and symptom assessments before and after the program, and again at follow-up.

Conditions

Primary Dysmenorrhea (PD)

Keywords

Graded Motor Imagery; Primary Dysmenorrhea; Primary dysmenorrhea and pressure pain threshold; Primary dysmenorrhea and altered pain sensitivity; Non-pharmacological intervention for primary dysmenorrhea

Outcome Measures

Primary Outcomes (2)

• Pain Pressure Threshold

  Pressure pain threshold will be measured at local abdominal and lumbar sites, and at a remote site over the tibialis anterior muscle by using a handheld algometer. Three readings will be taken at each site and averaged. Higher values will indicate lower pain sensitivity.

  Baseline, post-intervention at 6 weeks, and 4-week follow-up.

• Menstrual pain intensity

  Menstrual pain intensity will be assessed using a Numeric Rating Scale during active menstruation. Participants will rate their pain on the days of menstrual pain, and the scores will be recorded for comparison over time. Higher scores will indicate greater pain intensity.

  Baseline, 6 weeks post-intervention, and 4-week follow-up.

Secondary Outcomes (2)

• Menstrual symptom severity

  Baseline, 6 weeks post-intervention, and 4-week follow-up.

• Pain Catastrophizing

  Baseline, 6 weeks post-intervention, and 4-week follow-up.

Study Arms (3)

Graded Motor Imagery Protocol

EXPERIMENTAL

Participants in this arm will be engaged in a 6-week graded motor imagery program, consisting of two supervised sessions per week and daily home practice. The intervention will have three phases: laterality recognition training with images of the pelvis and abdomen, explicit motor imagery of pain-free abdominal and pelvic movements, and mirror therapy/visual feedback with a mirror box to produce the illusion of normal and pain-free lower abdominal movement. A trained physiotherapist will deliver online sessions, and participants will complete about 15 minutes of home practice each day, which will be recorded in a diary.

Behavioral: Graded Motor Imagery (GMI)

Sham Graded Motor Imagery

SHAM COMPARATOR

Participants in the sham group will undergo a program of the same amount of contact time as well as duration over 6 weeks with the same number of sessions. The sham intervention will consist of three phases. Sham laterality discrimination tasks will be performed with distal body parts only (e.g., hands and feet) and without pelvic content. Moreover, the sham general relaxation imagery will have peaceful scenes rather than body movement. Lastly, sham mirror exposure will be done by looking at a mirror showing the contralateral hand but not at the pelvic area. The sham protocol aims to control non-specific effects of therapist contact, attention, and imagery engagement, and to remove the pelvic-specific cortical engagement as occurred in the active component of GMI.

Behavioral: Sham Graded Motor Imagery

Wait-List Control

NO INTERVENTION

Participants in the wait-list group will receive no intervention throughout the 10-week study. They will be given standard written information regarding menstrual health and will be allowed to use analgesics as needed, which will be noted as a covariate.

Interventions

Graded Motor Imagery (GMI) BEHAVIORAL

The intervention will be a structured 6-week graded motor imagery program focused on the modulation of pain processing and sensorimotor representation in women with primary dysmenorrhea. It will consist of three sequential steps. Firstly, laterality recognition training with pelvic and abdominal body images. Secondly, explicit motor imagery with pain-free abdominal and pelvic movements. Finally, mirror therapy/visual feedback for normal pain-free movement. The program will be delivered online by a trained physiotherapist with two supervised sessions per week as well as daily home practice. This intervention is different from usual exercise or education because it mainly focuses on the cortical and sensorimotor mechanisms rather than only physical conditioning.

Graded Motor Imagery Protocol

Sham Graded Motor Imagery BEHAVIORAL

The intervention will be a sham 6-week graded motor imagery program in which the participants will undergo a program of the same amount of contact time as well as duration over 6 weeks with the same number of sessions. The sham intervention will consist of three phases. Sham laterality discrimination tasks will be performed with distal body parts only (e.g., hands and feet) and without pelvic content. Moreover, the sham general relaxation imagery will have peaceful scenes rather than body movement. Lastly, sham mirror exposure will be done by looking at a mirror showing the contralateral hand but not at the pelvic area. The sham protocol aims to control non-specific effects of therapist contact, attention, and imagery engagement, and to remove the pelvic-specific cortical engagement as occurred in the active component of GMI.

Sham Graded Motor Imagery

Eligibility Criteria

• Age: 18 Years - 30 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Female sex (aged 18-30 years)
• Diagnosis of primary dysmenorrhea confirmed by a physician (painful menstruation for ≥6 consecutive cycles, in the absence of identifiable pelvic pathology on clinical and/or ultrasound evaluation)
• Pain ≥4/10 NRS experienced during the last period.
• Confirmed altered pressure pain threshold: PPT ≥2 standard deviations below published norms for age-matched healthy women, measured at baseline assessment
• Regular menstrual cycle (21-35 days)
• Capable of engaging in virtual video sessions and taking online tests.
• Consent to withhold new analgesic or hormonal treatments during the study period.

You may not qualify if:

• Secondary dysmenorrhea (endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, ovarian cysts ≥3 cm confirmed on imaging)
• Current use of hormonal contraceptives (which alter prostaglandin levels and pain processing)
• Pregnancy or lactation
• Concurrent chronic pain condition (fibromyalgia, CRPS, chronic low back pain, chronic pelvic pain unrelated to menstruation)
• Neurological or psychiatric disorder that would impair motor imagery ability (stroke, schizophrenia, active psychosis)
• Cognitive impairment affecting informed consent capacity
• Participation in another clinical trial within 4 weeks before enrollment
• Previous exposure to graded motor imagery or mirror therapy
• Regular use of NSAIDs or opioids for non-menstrual indications

Sponsors & Collaborators

• Dr. Mehak Naeem: lead
• University of Health Sciences Lahore: collaborator

Study Sites (1)

Dr. Saqib Rabbani

Lahore, Punjab Province, 54782, Pakistan

RECRUITING

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Principle Investigator

Study Record Dates

• First Submitted: May 23, 2026
• First Posted: June 1, 2026
• Study Start: April 6, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): August 1, 2026
• Last Updated: June 2, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)