2019 News from the Research Team Articles

March 2019

Article Summary by IPPS Research Committee Member Dr. Laura Payne

Behavioral and Neural Responses to Aversive Visceral Stimuli in Women with Primary Dysmenorrhea

Bettina Böttcher, Elke R. Gizewski, Christian Siedentopf, Ruth Steiger, Michael Verius, David Riedl, Anja Ischebeck, Julia Schmid, Ludwig Wildt, and Sigrid Elsenbruch
European Journal of Pain, 2019

Summary: Summary: Women with primary dysmenorrhea (PDM) often show enhanced pain sensitivity to painful stimuli both on and outside areas of referred pain, suggesting the role of central sensitization in the pathophysiology of PDM. However, much less is known about the relationship of PDM and visceral pain stimuli, and how pain responses interact with endocrine and neural functioning. The current study compared 23 women with PDM and 23 healthy women. PDM was defined as self-reported menstrual pain of 54mm or higher on a 0 – 100mm visual analog scale of pain intensity. All participants completed the study at some point within days 1 – 5 of the menstrual cycle. Blood and urine samples were collected for analysis of luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone. Participants underwent a series of painful rectal distensions before and during a structural MRI and fMRI. Results indicated no group differences in pain threshold during rectal distension, as well as no group differences in neural activation in response to painful stimuli. These results contradict previous findings that have shown group differences in visceral pain thresholds and activation/deactivation of brain regions involved in pain processing. However, the authors acknowledge that their sample may have not had sufficient statistical power to test results. They conclude that PDM may not show a generalized interoceptive sensitization, particularly if there are no other psychological comorbidities present.

Conclusion: Indices of pain processing do not differ in women with PDM compared to healthy women, but other psychosocial factors, such as depression and anxiety, may play an important role in central sensitization in PDM.

February 2019

Article Summary by IPPS Research Committee Member Dr. Laura Payne

What Women Say About Their Dysmenorrhea: A Qualitative Thematic Analysis

Chen X. Chen, Claire B. Draucker, and Janet S. Carpenter
BMC Women’s Health, 2018

Summary: Dysmenorrhea (menstrual pain) is very common among reproductive-age women, and although many studies have focused on dysmenorrhea, very little is known about women’s individual experiences. This study aimed to better understand women’s thoughts and experiences related to dysmenorrhea through qualitative analysis in order to provide more personalized treatment approaches. Participants for the study were 762 women at least 18 years old who were living in the United States and reported having menstrual pain the last 6 months. An open-ended question was used for analysis: “Please write anything else you’d like to share with us about your dysmenorrhea experience.” Data were analyzed using a process to identify specific themes and patterns. Results indicated that 6 themes emerged, “(1) The dysmenorrhea symptom experience varied among women; (2) The dysmenorrhea symptom experience varied across time, (3) A variety of factors influenced the dysmenorrhea symptom experience, (4) Dysmenorrhea symptoms could have a negative impact on the women’s daily lives, (5) Dysmenorrhea was not seen as a legitimate health issue by the women, health care providers, or society, and (6) Treatment for women with dysmenorrhea varied in acceptability and effectiveness.” The authors suggest that these results indicate the need for improved assessment of dysmenorrhea symptoms, tracking of dysmenorrhea symptoms over time, and personalized approaches to interventions. Study findings may be limited by a recall bias in participants reporting past experiences of menstrual pain, as well as a sample selection bias by using the Internet for the survey.

Conclusion: Women have varied experiences with dysmenorrhea and personalized approaches are needed to address this significant problem.