Date of Award

2013

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not transdermal glyceryl trinitrate is a safe and effective treatment for primary dysmenorrhea.

STUDY DESIGN: Review of two English language randomized control trials (RCTs) published in 1996 and 1999 and one English language pilot study in 1997.

DATA SOURCES: Two double-blind, randomized, placebo-controlled cross-over studies and one pilot study comparing transdermal glyceryl trinitrate to placebo were found using PubMed, Medline and OVID.

OUTCOME MEASURED: Outcomes measured were based on pain intensity scores (PID) assessed on a visual analog scale and the time-weighted sum of pain intensity differences (SPID) in the Ali et al and Moya et al studies. Ali et al converted the SPID into percentages of pain relief, while Moya et al analyzed the PID and SPID using an analysis of varience (ANOVA) model. Pittrof et al used a visual analogue self-assessment form to evaluate efficiency, and results were reported as mean scores.

RESULTS: Pain relief from primary dysmenorrhea was considerably improved with glyceryl trinitrate therapy as seen in the randomized control trial by Moya et al. The remaining two studies in this systematic review were limited by study design and didn’t provide a definitive answer. The pilot study conducted by Ali et al failed to provide clinical significance because there was no control group for comparison, participants weren’t blinded and two different doses of the intervention were used at random. Pitroff et al did show improvement in patient symptoms, but had more than 20% of the participants lost to follow-up. The most common adverse effect of glyceryl trinitrate therapy was headache when compared to placebo.

CONCLUSION: The results of this selective EBM review are inconclusive, however do suggest that glyceryl trinitate may be a safe and effective treatment for primary dysmenorrhea. Due to limitations within these studies, this topic does warrant additional research.