INTRODUCTION:

Adolescence [10-19 yrs] is a period of growth which involves a stage of developmental transition and a bridge between childhood and adulthood. Nearly 10-20% of world population comprises of adolescents. In India one-fifth of the population [239 million] are adolescents between age group of 10-19 yrs.¹ Female adolescents’ account for the same proportion for the total female population as male adolescents for the male population. The population survey in Karnataka shows that 21 % of the total populations are adolescents.

Menstruation is the hallmark of female pubertal development; it is a normal physiological cycle, common to all girls of reproductive age group. In some culture, menstruation is considered dirty and is not fit to take part in social and religious activity^. Nearly half of the adolescent girls are unaware of the phenomena of menstruation prior to its onset and are therefore scarred at the time of its onset and unaware to disclose the problems related to menstruation to anyone. The prevalence of dysmenorrhea is very high and at least 50% of the women experience this problem throughout their reproductive years. Painful menstruation also called as primary dysmenorrhea is characterized by spasmodic or colicky pain and is worse on I, II, III days of menses. It usually occurs in girls and young females and tends to decrease with increasing age. (Arminder Singh, 2005) Dysmenorrhea is a leading cause for short-term school absence in adolescent school girls. In many girls it has also decrease their quality of life. In India 67.2% adolescent girls suffer from dysmenorrhea and 60% of them have disrupted daily routines. A study conducted in USA showed that 58% of girls suffered from severe menstrual flow, smoking and depression are some of the risk factors for dysmenorrhea. (French, 2005) Adolescent girls had been studied for menstrual problems and data were collected by personal interviews on a pre-tested semi-structured questionnaire. The result revealed that daily routines of the 60% girls were affected due to prolonged bed rest, missed school activities, disturbed sleep and decreased appetite. [7.24% had not been able to attend classes, 25% of them had to be abstained from work]. Hence there is a need to emphasize on designing menstrual health program for adolescent girls.(Sharma, 2007) A study was conducted in West Indies to determine the prevalence of dysmenorrhea on Hispanic female adolescents shows that 85% of them reported dysmenorrhea, 38% reported missing school due to dysmenorrhea, 33% reported missing individual classes. Activities affected included class concentration [59%], sports [51%], class participation [50%], socialization [46%], and homework [35%], test-taking skills [36%], and grades [29%]. Treatment taken for dysmenorrheal included rest [58%], medications [52%], heating pad [26%], tea [20%], exercise [15%] and herbs [7%]. The study concluded that adolescent girls with dysmenorrhea are affected by lack of attendance to school, concentration and other daily activities.

A variety of non-pharmaceutical measures are being used for reducing the pain during menstruation such as relaxation therapy, breathing techniques, touch and massage, music therapy, application of heat and cold, acupressure and acupuncture etc (Gurates,2008)^.Many studies have proved acupressure helps in reducing the primary dysmenorrhea. Acupressure techniques are one of the popular ancient alternative and complementary therapies. Recent research focusing on complementary and alternative interventions for dysmenorrhea include the use of muscle relaxation therapy, magnetic therapy, reflexology, hand acupuncture, moxibustion heat therapy, aroma therapy, acupuncture and acupressure. Acupuncture and acupressure are based on traditional Chinese medicine and share the main principle of opening and harmonizing an obstructed meridian by stimulating surrounding acupuncture points. Experimental studies on acupressure and acupuncture have demonstrated their effectiveness in alleviating discomfort through sedative and analgesic effects. Many studies have shown that acupuncture is effective for pain relief in general and acupuncture of specific sites such as the SP6 point has been reported to alleviate dysmenorrhea. The SP6 acupoint is the junction point of the liver, spleen, and kidney meridians, and it is proposed to strengthen the spleen, resolve and expel dampness, and restore balance to the Yin and blood, liver, and kidneys.

Acupressure can be adopted as nursing interventions to alleviate dysmenorrhea improve productivity, creativity, work performance and quality of life. It is a healing act using the fingers to skillfully press the points which stimulate the body’s natural self, creative abilities. When these trigger points are pressed, it releases muscular tension and promote circulation of blood and body’s life force energy to aid healing. Acupressure point called ‘SP6’ point is used for menstruation pain. This point is located in 4 fingers above the lateral medial malleolus bone. (Wong et.al, 2009)

An experimental study was conducted among 58 Korean young college women in two universities to evaluate the effects of the SP-6 acupressure on dysmenorrhea. The experimental group received acupressure within first 8hr of menstruation and the severity of dysmenorrhea was assessed prior to and 30min, 1, 2 and 3hr following the treatment. The results revealed that there was a significant difference in severity of dysmenorrheal between the two groups immediately after [F=18.50, P=0.000] and for unto 2hr [F=8.04, P=0.032] post treatment. It was concluded that acupressure to SP6 meridian can be an effective non-invasive nursing intervention for alleviation of primary dysmenorrhea, with effects lasting 2hr post treatment.

The nurse has an important task in conducting school health programme and educating adolescent girls as well as community regarding the various non-pharmaceutical measures and its effectiveness in controlling menstrual pain perception. In turn such education helps the adolescent girls to be equipped and empowered with knowledge and skills to face the future effectively.

During school health programme, the investigator observed that most of the girls were absent due to painful menstruation or primary dysmenorrheal. Hence based on the above information, the researcher is motivated to act on and implement the pain relief measures for adolescent girls and empower them to manage dysmenorrhea. Hence the study is intended to assess the effectiveness of acupressure on menstrual pain perception among adolescent girls in selected schools.

STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of acupressure on menstrual pain among adolescent girls with dysmenorrhea at selected schools in Erode.

OBJECTIVES:

1. To assess the level of menstrual pain among control adolescent girls with dysmenorrhea before and after acupressure

2. To assess the level of menstrual pain among experimental group adolescent girls with dysmenorrhea before and after acupressure

3. To compare the effectiveness of acupressure on menstrual pain among adolescent girls with dysmenorrhea in both the groups

4. To find out the association between post test scores of menstrual pain among experimental group and control group of adolescent girls with dysmenorrhea with their selected demographic variables.

OPERATIONAL DEFINITION:

1. Acupressure:

Acupressure Points and Location
1. Sanyinjiao point (San Yin Jiao (S_P6) This is located on the inside of leg, just above ankle. To find this point, (1) locate the highest peak of the ankle (2) four finger widths up leg, apply deep pressure slightly behind the bone (tibia) 2. Grandfather Grandson ( S_P4) This point is located in the upper arch of the foot, one thumb width from the ball of the foot. Apply deep pressure slightly behind the bone.

Technique / Procedure

1. The adolescent girls was made to lie down/ sit comfortably

2. The investigator was given acupressure to the alternate legs at the Sanyinjiao point (San Yin Jiao (S_P6) and Grandfather Grandson (S_P4) acupoints. For each pressure cycle on each side S_P6 and S_P4 was pressed with a thumb for 6 seconds and released for 2 seconds without pressure.

3. This was continued for 5 minutes on each point on each leg, to bring the total duration of 20 minutes

4. Treatment duration 20 minutes (10 minutes in each leg) once in day for 6 days. (3 days before menstruation and 3 days after menstruation)

RESEARCH HYPOTHESIS:

H₁: There will be a significant reduction in menstrual pain among control than experimental group of adolescent girls with dysmenorrhea before and after acupressure.

H₂: There will be a significant effectiveness of acupressure on menstrual pain among adolescent girls with dysmenorrhea.

H₃: There will be a significant association between post test scores of menstrual pain among experimental group and control group of adolescent girls with dysmenorrhea with their selected demographic variables.

METHODOLOGY:

Quantitative research design – True Experimental design – pre and post test with control group design. The study was conducted with permission of Head Master from SDA School, Erode. The sample consisted of 30 adolescent girls with dysmenorrhea who fulfil the inclusion criteria were chosen for the study by using simple random sampling technique. The tools used to collect the data were demographic variables and Visual analogue pain scale. The experimental group received acupressure once in a day for 6 days. Both the groups’ data were collected after 4^th day of menstruation. Descriptive and inferential statistical methods were used to analyse the data.

RESULTS AND DISCUSSIONS:

The study findings showed that majority of the sample (87% and 73%) were in the age group of 13 years, 80 and 67% were educated, 87 and 73% were age at menarche 12 years, 80% and 83% of them had 7 days menstrual flow, 86% and 73% of them had 21 – 24 days menstrual cycle ad family history of dysmenorrhea.

1. Level of menstrual pain among control group adolescent girls with dysmenorrhea before and after acupressure reveals that, in control group during pre test majority (80%) of them were severe pain and 20% of them were moderate pain whereas in post test 70% of the had severe pain and 30% of them had moderate pain.

2. Level of menstrual pain among experimental group adolescent girls with dysmenorrhea before and after acupressure reveals that, in experimental group during pre test majority (87%) of them were severe pain and 13% of them were moderate pain whereas in post test 93% of the had mild pain and 7% of them had moderate pain.

3. Level of menstrual pain among control and experimental group adolescent girls with dysmenorrhea after acupressure reveals that, in control group during post test majority (70%) of them were severe pain and 30% of them were moderate pain whereas in experimental group most (93%) of the had mild pain and 7% of them had moderate pain.

Compare the effectiveness of acupressure on menstrual pain among adolescent girls with dysmenorrhea in both the groups reveals that,

Adolescent girls with dysmenorrhea	Before Intervention
Adolescent girls with dysmenorrhea	Mean	SD	Mean %
Control group	7.32	1.23	73
Experimental group	7.52	1.26	75

Adolescent girls with dysmenorrhea	After Intervention			Paired ‘t’ test P < 0.05
Adolescent girls with dysmenorrhea	Mean	SD	Mean %	Paired ‘t’ test P < 0.05
Control group	6.83	1.18	68	4.26
Experimental group	3.13	0.83	30	18.47

The paired ‘t’ test value was 4. 26 in control group whereas in experimental group 18.47 which was statistically highly significant at p< 0.05 level. Avinash Kaur Rana (2014) recommended that there was significant difference in the mean pain score of Numerical Pain Rating Scale before intervention, immediately after, at 1 hour, at 2 hour and at 3 hour was 6.05, 4.05, 3.35, 2.68 and 2.24 respectively. Mean score of Modified Menstrual Distress Questionnaire was 24.65 before applying acupressure and after it was reduced to 9.98. The repeated measure ANOVA was applied in subsequent observations determined statistically significant reduction in the severity of dysmenorrhea (p< 0.001). So, acupressure is an effective way in reducing dysmenorrhea.

There is no statistical significant association was found in post test scores of level of menstrual pain among adolescent girls with dysmenorrheal in control group and experimental group with demographic variables such as age, education, age at menarche, Duration of menstrual flow, days of menstrual cycle and family history of dysmenorrheal at P<0.05 level of significance.

CONCLUSION:

The present study assessed the effectiveness of acupressure on menstrual pain among adolescent girls with dysmenorrheal. The study findings revealed that acupressure was effective in reducing dysmenorrheal among adolescent girls. It is simple, effective and safe method. This method practiced during menstrual period is more helpful for the adolescent girls to enhance the menstrual pain and distress. The study suggests that long term acupressure use will not cause any problems in the menstrual complications.

REFERENCES:

1. National Family Health Survey, Report of the Working Group on adolescents for the Tenth Five Year Plan, GOI, Planning Commission, June 2001.

2. Dutta. D.C Textbook of Gynecology. 6 Ed Calcutta: New Central Book Agency; 2004.p.565

3. Arminder Singh et. al. Prevalance severity of dysmenorrheal: A problem related to menstruation. Indian Journal of Physiological Pharmacology, 2008: 52 [4]; 389-97

4. French L. Dysmenorrhea, American Family Physician, 2005; 71[2]: 285- 91

5. Gurates. B. Severity of pain and management in primary dysmenorrhea, Achieves Gynecological Obstetrics, 2009:14 [2]; 421-25.

6. Wang. M.C. et.al. Effects of circular acupressure on menstrual symptoms for women with primary dysmenorrhea: Journal of alternative and complementary medicine, 2009; 15 [3]: p.242-53.

7. Banikarim. C, Chacke. M.R, Kelder S.H. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatric Adolescents. 2000 Dec; 154 [12]:1226-29.

8. Agarwal AK, A study of dysmenorrhea during menstruation in adolescent girls. Indian Journal of Community Medicine 2010; 35:159-64

9. Jun EM, Chang S, Kang DH, Kim S. Effects of acupressure on dysmenorrhea and skin temperature changes in college students: a non-randomized controlled trial. International Journal for Nursing Students. 2007 Aug; 44 [6]: 973-81

10. Esha Sharma, Avinash Kaur Rana, Amarjit Singh, An interventional study to assess the effectiveness of acupressure at SP6 point on dysmenorrhea among B. Sc Nursing Students, Nursing and Midwifery Research.

Received on 11.09.2015 Modified on 28.09.2015

Int. J. Adv. Nur. Management 4(1): Jan. - Mar. 2016; Page 1-5

DOI: 10.5958/2454-2652.2016.00001.9