Pain Neuroscience Education Versus Biomedical Pain Education with Exercise in Primary Dysmenorrhea: A Randomized Controlled Trial

<b>Background/Objectives:</b> Although pain education is a very important component of chronic pain management, its effects on primary dysmenorrhea (PD) have not been investigated. The aim of this study was to compare the effects of pain neuroscience education (PNE) or biomedical pain education (BPE) combined with exercise training (ET) in PD. <b>Methods:</b> Individuals with PD were randomly assigned to PNE or BPE combined with ET (stretching and relaxation exercises) for two menstrual cycles. The PNE focused on pain neurobiology, central sensitization, and brain pain-modulation mechanisms, while the BPE included anatomical and biomechanical explanations of pain. Assessments were conducted at the start of the study, after the intervention period, and at the one-month follow-up after the intervention. The primary outcome measure was menstrual pain (mean and maximum pain) intensity, while the secondary outcome measures included menstrual stress, central sensitization symptoms, and pain catastrophizing. <b>Results:</b> All the individuals assigned to the PNE+ET (<i>n</i> = 19) and BPE+ET (<i>n</i> = 19; control) groups were included in the analysis. PNE or BPE with ET led to improvements in all outcome measures (<i>p</i> < 0.05). Furthermore, PNE was found to reduce menstrual pain, central sensitization symptoms, and pain catastrophizing more after the intervention and at follow-up compared to BPE (<i>p</i> < 0.05, Cohen's d = 0.683-1.174). However, menstrual stress decreased at similar levels in both groups (<i>p</i> > 0.05). <b>Conclusions:</b> The combination of PNE or BPE with ET was demonstrated to be an effective approach for the management of menstrual pain and stress in PD. Furthermore, PNE appears to be more efficacious in addressing menstrual pain, symptoms of central sensitization, and pain cognition compared with BPE. Further studies could investigate the combination of PNE with different education parameters and physiotherapy methods to manage PD.