As per the findings of a recently conducted three-arm randomized controlled trial, rhythmical massage can be employed as an efficient approach to improve dysmenorrhea associated pain after 12 weeks. Other treatment regimens such as oral contraceptives and NSAIDs are also available, but with associated side effects. Therefore the investigators introduced the rhythmical massage and heart rate variability (HRV) biofeedback in comparison to the usual care to alleviate pain among women with primary dysmenorrhea.

Both, HRV biofeedback 15 min daily and rhythmical massage once a week were administrated across a period of three months. Some of the participants received usual care and considered as controls. Between-group differences during menstruation after three months measured by the Numeric Rating Scale (NRS) were taken as the primary outcome, and Quality of life (SF-12 questionnaire), heart rate variability and use of analgesics were considered as secondary outcomes.

A total of 60 females; 20 in biofeedback group, 23 in the rhythmical massage and 17 in the control group were analyzed. The groups exhibited a notable difference in the primary outcome after three months. As per the findings of Bonferroni adjusted posthoc tests, rhythmical massage group and control group showed a significant difference. Comparison of rhythmical massage & biofeedback groups and biofeedback & control groups showed no notable differences. Regarding secondary outcomes, no meaningful difference was reported between the groups. Further, as compared to the massage and control groups, the biofeedback group exhibited higher drop-out rates. 

The alternative approach like rhythmical massage provides significant outcomes, but an assessment of further studies with a more extended observation period is required.