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Dysmenorrhea, as one of the gynecological problems that appears before or during the menstruation period among reproductive women, shows symptoms in the lower abdomen and spreads to back pain, and its severity varies from mild, moderate, and severe levels (1,2). School absence and severe pain felt at the time dysmenorrhea can have psychological, physical, and social consequences among adolescents (3,4). The primary dysmenorrhea commonness is up to 90% (5) and varies in different regions. For instance, its range was reported by 78.3% (6), 69.3% (7), 85.1% (8), and 90.1% (9) in Korea, Ethiopia, Palestine, and Jordan, respectively. The high level of F2α prostaglandin hormone (PGF2α) release from endometrium was one reason for the appearance of primary dysmenorrhea with symptoms such as abdominal pain, uterine cramps, and uterine muscle contraction (10-13). Studies have shown that the pro-inflammatory cytokines, including interleukin 1 β, tumor necrosis factor (TNF), interleukin (IL)-6, and IL8, significantly increase on the first day of menstruation. These cytokines can induce PGF2α and oxytocin synthesis, and uterus hypercontractility and reduce endometrial blood flow, and eventually pain (14,15). Contraceptive pills and nonsteroidal anti-inflammatory drugs commonly consumed to treat dysmenorrhea have several side effects. Based on the gate control theory, acupressure, warm or cold compress, and slow-stroke back massage (SSBM) can be an alternative treatment for dysmenorrhea. A skin stimulation by SSBM causes endorphins releases that block pain transmission (16). Several studies also suggested that SSBM and acupressure at the Sanyinjiao point effectively reduced the intensity of menstrual pain (17-19), and traditional Malay massage could reduce several pro-inflammatory mediators (i.e., TNF-α, IL-1β, IL-8, monocyte chemotactic protein-1, IL-6, and IL-10) related to dysmenorrhea (20). So far, no research has examined the SSBM effect on pro-inflammatory cytokines levels in dysmenorrhea. Therefore, this study aimed to observe the SSBM effect on β-endorphin levels, IL-6, TNF-α, and menstrual pain intensity (MPI).

The Effect of Slow Stroke Back Massage on Primary Dysmenorrhea: Levels of Beta-Endorphin, Interleukin-6, Tumor Necrosis Factor-α, and Pain Intensity