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Lin T, Allaire C, As-Sanie S, Stratton P, Vincent K, Adamson GD, Arendt-Nielsen L, Bush D, Jansen F, Longpre J, Rombauts L, Shah J, Toussaint A, Hummelshoj L, Missmer SA, Yong PJ. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: V. Physical examination standards in endometriosis research. Fertil Steril 2024; 122:304-315. [PMID: 38508508 DOI: 10.1016/j.fertnstert.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The World Endometriosis Research Foundation established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, 4 data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies. DESIGN An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards underwent multiple rounds of iterations and revisions. SUBJECTS N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect-PE tool provides standardized assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of back and pelvic girdle; abdomen including allodynia and trigger points; vulva including provoked vestibulodynia; pelvic floor muscle tone and tenderness; tenderness on unidigital pelvic examination; presence of pelvic nodularity; uterine size and mobility; presence of adnexal masses; presence of incisional masses; speculum examination; tenderness and allodynia at an extra-pelvic site (e.g., forearm); and recording of anthropometrics. CONCLUSION(S) The EPHect-PE standards will facilitate the standardized documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain.
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Affiliation(s)
- Tinya Lin
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | | | - Katy Vincent
- Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - G David Adamson
- World Endometriosis Research Foundation (WERF); Department of Obstetrics & Gynecology, Stanford University, Palo Alto, California
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Mech-Sense, Aalborg, Denmark
| | | | - Femke Jansen
- World Endometriosis Organisations (WEO); EndoHome - Endometriosis Association Belgium, Belgium
| | - Jennifer Longpre
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Luk Rombauts
- World Endometriosis Research Foundation (WERF); Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Jay Shah
- National Institutes of Health, Bethesda, Maryland
| | - Abeesha Toussaint
- World Endometriosis Organisations (WEO); Trinidad and Tobago Endometriosis Association, Port of Spain, Trinidad and Tobago
| | | | - Stacey A Missmer
- World Endometriosis Research Foundation (WERF); Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
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Mazza M, Margoni S, Mandracchia G, Donofrio G, Fischetti A, Kotzalidis GD, Marano G, Simonetti A, Janiri D, Moccia L, Marcelli I, Sfratta G, De Berardis D, Ferrara O, Bernardi E, Restaino A, Lisci FM, D'Onofrio AM, Brisi C, Grisoni F, Calderoni C, Ciliberto M, Brugnami A, Rossi S, Spera MC, De Masi V, Marzo EM, Abate F, Boggio G, Anesini MB, Falsini C, Quintano A, Torresi A, Milintenda M, Bartolucci G, Biscosi M, Ruggiero S, Lo Giudice L, Mastroeni G, Benini E, Di Benedetto L, Caso R, Pesaresi F, Traccis F, Onori L, Chisari L, Monacelli L, Acanfora M, Gaetani E, Marturano M, Barbonetti S, Specogna E, Bardi F, De Chiara E, Stella G, Zanzarri A, Tavoletta F, Crupi A, Battisti G, Monti L, Camardese G, Chieffo D, Gasbarrini A, Scambia G, Sani G. This pain drives me crazy: Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome. World J Psychiatry 2024; 14:954-984. [PMID: 38984334 PMCID: PMC11230088 DOI: 10.5498/wjp.v14.i6.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Interstitial cystitis/bladder pain syndrome (IC/BPS) is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic, abdominal, and/or pelvic pain. Although the term cystitis suggests an inflammatory or infectious origin, no definite cause has been identified. It occurs in both sexes, but women are twice as much affected. AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS. METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS, we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy: ("interstitial cystitis" OR "bladder pain syndrome") AND ("mood disorder" OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk). RESULTS On September 27, 2023, the PubMed search produced 223 articles, CINAHL 62, and the combined PsycLIT/ PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36. Search on ClinicalTrials.gov produced 14 studies, of which none had available data. Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS, i.e. 63 articles spanning from 2000 to October 2023. These studies identified depression and anxiety problems in the IC/BPS population, along with sleep problems and the tendency to catastrophizing. CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS. Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stella Margoni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Guglielmo Donofrio
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessia Fischetti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Giuseppe Marano
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Delfina Janiri
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lorenzo Moccia
- Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Ilaria Marcelli
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Greta Sfratta
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Ottavia Ferrara
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Evelina Bernardi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Antonio Restaino
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | | | - Caterina Brisi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Claudia Calderoni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Michele Ciliberto
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Andrea Brugnami
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Rossi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Chiara Spera
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Valeria De Masi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Ester Maria Marzo
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesca Abate
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gianluca Boggio
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Cecilia Falsini
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Anna Quintano
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alberto Torresi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Miriam Milintenda
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Bartolucci
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Marco Biscosi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Ruggiero
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Lo Giudice
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giulia Mastroeni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Elisabetta Benini
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Di Benedetto
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Romina Caso
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Pesaresi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Traccis
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Onori
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Chisari
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Monacelli
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Mariateresa Acanfora
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Eleonora Gaetani
- Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Monia Marturano
- Division of Gynecologic Oncology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Elettra Specogna
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesca Bardi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Emanuela De Chiara
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gianmarco Stella
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Andrea Zanzarri
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flavio Tavoletta
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Arianna Crupi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giulia Battisti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Laura Monti
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Chieffo
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome 00168, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health, Catholic University, Rome 00168, Italy
| | - Gabriele Sani
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
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Chen CX, Rogers SK, Li R, Hinrichs RJ, Fortenberry JD, Carpenter JS. Social Determinants of Health and Dysmenorrhea: A Systematic Review. THE JOURNAL OF PAIN 2024:104574. [PMID: 38788887 DOI: 10.1016/j.jpain.2024.104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Social determinants of health play a key role in health disparities. Dysmenorrhea is a highly prevalent and impactful public health problem affecting reproductive-age females. Systematically examining social determinants of health (SDoH) in dysmenorrhea is important for identifying gaps in the literature and informing research, policy, and clinical practice to reduce the public health burden associated with dysmenorrhea. The purpose of this systematic review was to synthesize the literature on SDoH and dysmenorrhea. The review protocol was prospectively registered. We searched Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Google Scholar through February 2024 using search strategies informed by the literature. Screening of the articles, data extraction, and risk-of-bias (RoB) assessment were conducted independently by at least 2 reviewers on the Covidence platform. Among 2,594 unique records screened, 166 met eligibility criteria and were included for data extraction and RoB assessment. Evidence suggests traumatic experiences, toxic environmental exposures, female genital mutilation, job-related stress, lack of menstrual education, and low social support were associated with worse dysmenorrhea outcomes. However, evidence was equivocal regarding the relationships between dysmenorrhea outcomes and SDoH factors, including socioeconomic status, geographical location, race/ethnicity, employment, and religion. Nearly all articles (99.4%) had a high or very high overall RoB. The relationships between SDoH and dysmenorrhea outcomes were often inconsistent and complicated by heterogeneous study populations and methodologies. More rigorous research examining SDoH in dysmenorrhea is needed to inform policy and clinical practice. PERSPECTIVE: This systematic review synthesizes evidence linking SDoH and dysmenorrhea. The relationships between SDoH and dysmenorrhea were often equivocal and complicated by heterogeneous study populations and methodologies. We identify directions for future research and SDoH factors that could be addressed clinically (eg, trauma, menstrual education, and occupational stress).
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Affiliation(s)
- Chen X Chen
- Indiana University School of Nursing, Indianapolis, Indiana.
| | - Sarah K Rogers
- Department of Psychology, School of Science, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana
| | - Rui Li
- Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Rachel J Hinrichs
- Indiana University Indianapolis, University Library, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Tu FF, Hellman KM, Darnell SE, Harber KA, Bohnert AM, Singh L, Walker LS. A multidimensional appraisal of early menstrual pain experience. Am J Obstet Gynecol 2024; 230:550.e1-550.e10. [PMID: 38290643 PMCID: PMC11165568 DOI: 10.1016/j.ajog.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/01/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Symptomatic dysmenorrhea is a global problem, affecting more than 40% of menstruating persons. Cross-sectional studies have implicated psychosocial, biological, and sensory factors in dysmenorrhea but the mechanisms are not fully understood. Only a few prospective longitudinal studies have evaluated such factors in relation to the emergence and course of dysmenorrhea at menarche. OBJECTIVE This study aimed to describe the initial menstruation experience and to evaluate the association of premenarchal psychosocial and sensory factors with the intensity of dysmenorrhea during the period in the fourth month. STUDY DESIGN This was a prospective cohort study of adolescents who completed premenarchal assessments and postmenarchal daily menstrual diaries for their first (n=149) and fourth month periods (n=114). They were recruited shortly before menarche and completed baseline assessments, including psychosocial questionnaires and experimental pain sensitivity (pressure testing, bladder provocation), and their parents completed related pain questionnaires. The relation between the hypothesized premenarchal factors and month 4 dysmenorrhea intensity was evaluated using Kruskal-Wallis and chi-square tests for low (<3 on a 0-10 scale) vs higher (≥3) menstrual pain groups based on maximal pain ratings recorded in a daily diary. RESULTS Low levels of dysmenorrhea characterized the first (median, 1; interquartile range, 0-2) and fourth month periods (1; 0-3). Maximal pain ratings increased from the first to the fourth period (3; 1-5 vs 4; 1-6; P=.007). The distribution of dysmenorrhea was multimodal at month 4 with 31.6% of the participants having low levels of maximal pain (1; 0-1) and 68.4% having higher levels (5; 4-6; Hartigan's dip test P<.001). The baseline demographic, psychosocial, and parental pain characteristics were not associated with the development of worse dysmenorrhea. The baseline experimental pain sensitivity, based on pressure pain thresholds, did not differ between the low (15.7 N; 12.5-22.3) and higher (15.0 N; 10.9-21.4]) level dysmenorrhea groups. Baseline bladder pain at first urge also did not differ (low, 6; 0-20 vs higher, 7; 0-19). CONCLUSION By their fourth month period, two-thirds of adolescents fell into the higher group for maximal dysmenorrhea, half reported some related impairments in physical activity, and one-seventh reported some related school absence. Premenarchal factors (experimental pain sensitivity, psychosocial profile, parental pain experience) linked to chronic pain emergence in the adult literature did not predict dysmenorrhea intensity, suggesting the dominant factor at menarche may be peripheral afferent activation. Further research is needed to understand the evolution of psychosocial and sensory mechanisms in the development and course of dysmenorrhea.
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Affiliation(s)
- Frank F Tu
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL; Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
| | - Kevin M Hellman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL; Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Sarah E Darnell
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Kaela A Harber
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Amy M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, IL
| | - Lynn S Walker
- Department of Psychology, Vanderbilt University, Nashville, TN
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5
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Hellman KM, Tu FF. Hal, how many types of pelvic pain are there? Pain 2024:00006396-990000000-00550. [PMID: 38564003 DOI: 10.1097/j.pain.0000000000003219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Kevin M Hellman
- Department of Ob/Gyn, Endeavor Health, Evanston, IL, United States
- Department of Ob/Gyn, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, Endeavor Health, Evanston, IL, United States
- Department of Ob/Gyn, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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Luna-López BL, Zatarain-Mendívil JP, Peña-Borrego J, Cortez-Hernández J, Favela-Heredia C, Murillo-Llanes J, Canizalez-Roman A, Leon-Sicairos N, Barajas-Olivas MF, Morgan-Ortíz F, Magaña-Ordorica D, Castro-Apodaca F. Unusual Manifestation of Membranous Dysmenorrhea: Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941946. [PMID: 38111179 PMCID: PMC10750218 DOI: 10.12659/ajcr.941946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/15/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND In the 18th century, Morgagni described membranous dysmenorrhea as the sudden and complete detachment of the decidua during menstruation. This causes intense and painful contractions of the myometrium, aggravated by the expulsion of tissues produced by the decidualization of the endometrium. It is a rare pathology associated with oral contraceptives, ectopic pregnancies, abortions, and natural cycles, with consequent thickening and endometrial decidualization with molding of the tissue of the uterine cavity of membranous appearance. The definitive diagnosis is made by histopathological examination. CASE REPORT A 43-year-old female patient came for urgent consultation for an acute picture of severe pain in the lower abdomen, radiating to the genital area with transvaginal bleeding of 2 h of evolution. She had no significant past medical history. A transvaginal ultrasound was performed and showed an unchanged endometrial cavity. A vaginal examination revealed a foreign body of soft consistency; therefore, a speculum examination was performed, which showed tissue of endometrial origin located in the cervical canal of a reddish spongy texture. The tissue was removed, thus improving the symptomatology, and was sent to the pathological anatomy service for histopathologic diagnosis. CONCLUSIONS Membranous dysmenorrhea is a rare gynecologic disorder with only a few documented cases. According to other case reports, our patient's case, at age 43 years, was an atypical presentation. The clinical features and association with this pathology allowed the diagnosis and its confirmation by histopathological examination.
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Affiliation(s)
- Brianda Lizett Luna-López
- Department of Gynecology and Obstetrics, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
| | | | - Jennifer Peña-Borrego
- Department of Gynecology and Obstetrics, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
| | - Jesús Cortez-Hernández
- Department of Pathology, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
| | - César Favela-Heredia
- Department of Gynecology and Obstetrics, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
| | - Joel Murillo-Llanes
- Department of Education and Research, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
| | - Adrian Canizalez-Roman
- Department of Education and Research, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | - Nidia Leon-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
- Department of Research, Pediatric Hospital of Sinaloa, Culiacan, Sinaloa, Mexico
| | - Mario F. Barajas-Olivas
- Department of Education and Research, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
| | - Fred Morgan-Ortíz
- Department of Gynecology and Obstetrics, CIDOCS, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | | | - Francisco Castro-Apodaca
- Department of Gynecology and Obstetrics, The Women’s Hospital, Secretariat of Health, Culiacan, Sinaloa, Mexico
- School of Nutrition, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
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7
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Fang X, Liu H, Wang M, Wang G. Scientific Knowledge Graph of Dysmenorrhea: A Bibliometric Analysis from 2001 to 2021. J Pain Res 2023; 16:2883-2897. [PMID: 37638206 PMCID: PMC10460176 DOI: 10.2147/jpr.s418602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose This study aims to help researchers master the most active hotspots and trends quickly through bibliometric analysis in the field of dysmenorrhea. Methods We retrieved literature on Web of Science from 2001 to 2021, and bibliometric analysis software CiteSpace was used in combination with VOSviewer. Results We finally acquired 944 papers and an upward trend in articles continued in this field overall. Through the map, China contributed the most, followed by the USA and Turkey. For institutions, Beijing University of Chinese Medicine in China contributed the most, followed by National Yang-Ming University in Taiwan, China. Hsieh JC and Hellman KM were both the most prolific authors with 14 articles. Five major research groups, respectively, with Hsieh JC, Hellman KM, Zhu J, Liang F and Dun W were the key group. Dawood MY was the most dominant author and most frequently cited author. The Cochrane Database of Systematic Reviews Journal was the most productive, and the Fertility and Sterility Journal was the most cited. Advances in pathogenesis and management for primary dysmenorrhea written by Dawood MY was most cited and influential. Pathophysiology, the potential central mechanism, syndrome, evaluation index, diagnosis of adenomyosis-associated dysmenorrhea, treatment, etc., were the main trends and hotspots. Conclusion Dysmenorrhea research has received a lot of attention from scholars. Strengthening international cooperation may promote the development of this field. The pathophysiology of dysmenorrhea, its impact on public health and its treatment are current research hotspots and are likely to be the focus of future study.
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Affiliation(s)
- Xiaoting Fang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Haijuan Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Mina Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Guohua Wang
- Gynecology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
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MacGregor B, Allaire C, Bedaiwy MA, Yong PJ, Bougie O. Disease Burden of Dysmenorrhea: Impact on Life Course Potential. Int J Womens Health 2023; 15:499-509. [PMID: 37033122 PMCID: PMC10081671 DOI: 10.2147/ijwh.s380006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
Dysmenorrhea is the most common gynecologic condition among the female population and has a significant impact on life course potential. It has a widespread impact on a female's mental and physical well-being, with longstanding impairments on quality of life, personal relationships, and education and career attainment. Furthermore, untreated dysmenorrhea can lead to hyperalgesic priming, which predisposes to chronic pelvic pain. Primary dysmenorrhea is pain in the lower abdomen that occurs before or during menses and in the absence of pelvic pathology. One possible mechanism is endometrial inflammation and increased prostaglandin release, resulting in painful uterine contractions. Dysmenorrhea may also occur secondary to pelvic pathology, such as endometriosis, adenomyosis or due to cyclic exacerbation of non-gynecologic pain conditions. A thorough patient evaluation is essential to differentiate between potential causes and guide management. Treatment must be tailored to individual patient symptoms. Pharmacologic management with non-steroidal anti-inflammatory medications and/or combined hormonal contraceptives is most common. Heat therapy, exercise, vitamins and dietary supplements have limited evidence and can be offered for patients seeking non-pharmacologic adjunctive or alternative options. Greater awareness for both health-care providers and patients allows for early intervention to reduce impact on quality of life and life course potential.
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Affiliation(s)
- Brittany MacGregor
- Department of Obstetrics and Gynaecology, University of British Columbia, BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynaecology, University of British Columbia, BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
- Paul J Yong, Department of Obstetrics & Gynecology, University of British Columbia, FRCSC, F2 – 4500 Oak Street, Vancouver, British Columbia, V6H3N1, Canada, Email
| | - Olga Bougie
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, Canada
- Correspondence: Olga Bougie, 76 Stuart Street, Victory 4, Department of Obstetrics & Gynecology, Queen’s University, Kingston, Ontario, Canada, K7L 2V7, Email
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Shlobin AE, Tu FF, Sain CR, Kmiecik MJ, Kantarovich D, Singh L, Wang CE, Hellman KM. Bladder Pain Sensitivity Is a Potential Risk Factor for Irritable Bowel Syndrome. Dig Dis Sci 2023:10.1007/s10620-023-07868-7. [PMID: 36879177 DOI: 10.1007/s10620-023-07868-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Although dysmenorrhea is a highly prevalent risk factor for irritable bowel syndrome (IBS), the factors underlying this risk are not fully understood. Prior studies support a hypothesis that repeated distressing menstrual pain promotes cross-organ pelvic sensitization with heightened visceral sensitivity. AIMS To further explore cross-organ pelvic sensitization we examined the association of dysmenorrhea, provoked bladder pain, and other putative factors with self-reported IBS-domain pain frequency and new onset after 1-year follow up. METHODS We measured visceral pain sensitivity with a noninvasive provoked bladder pain test in a cohort of reproductive-aged women, enriched for those reporting moderate-to-severe menstrual pain intensity but without any prior IBS diagnosis (n = 190). We analyzed the relationship between menstrual pain, provoked bladder pain, pain catastrophizing, anxiety, and depression with primary outcomes: (1) frequency of self-reported IBS-domain pain and (2) new onset of IBS-domain pain after 1-year follow up. RESULTS All hypothesized factors correlated with the frequency of IBS-domain pain (p's ≤ 0.038). In a cross-sectional model, only menstrual pain (standardized adjusted odds ratio 2.07), provoked bladder pain (1.49), and anxiety (1.90) were independently associated with IBS-domain pain ≥ 2 days/month (C statistic = 0.79). One year later, provoked bladder pain (3.12) was the only significant predictor of new onset IBS-domain pain (C statistic = 0.87). CONCLUSION Increased visceral sensitivity among women with dysmenorrhea could lead to IBS. Because provoked bladder pain predicted subsequent IBS, prospective studies should be performed to see if the early treatment of visceral hypersensitivity mitigates IBS.
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Affiliation(s)
- Arielle E Shlobin
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, 60201, USA
| | - Frank F Tu
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, 60201, USA
- Department of Obstetrics & Gynecology, The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA
| | - Cody R Sain
- Department of Obstetrics & Gynecology, The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA
| | - Matthew J Kmiecik
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, 60201, USA
- Department of Obstetrics & Gynecology, The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA
| | - Diana Kantarovich
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA
| | - Lavisha Singh
- Department of Biostatistics, Northshore University Health System, Evanston, IL, 60201, USA
| | - Chi E Wang
- Department of Biostatistics, Northshore University Health System, Evanston, IL, 60201, USA
| | - Kevin M Hellman
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, 60201, USA.
- Department of Obstetrics & Gynecology, The University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, USA.
- Department of Obstetrics & Gynecology, Evanston Hospital, Walgreen's Bldg 1507, 2650 Ridge Ave, Evanston, IL, 60201, USA.
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10
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Schrepf A, Hellman KM, Bohnert AM, Williams DA, Tu FF. Generalized sensory sensitivity is associated with comorbid pain symptoms: a replication study in women with dysmenorrhea. Pain 2023; 164:142-148. [PMID: 35543649 PMCID: PMC9704354 DOI: 10.1097/j.pain.0000000000002676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/04/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Dysmenorrhea is characterized by high rates of transition to chronic pain. In a previous study using structural equation modeling, we demonstrated that several symptom domains associated with the emerging concept of nociplastic pain can be described using 2 symptom groups: generalized sensory sensitivity (GSS; composed of widespread pain, interceptive sensitivity, and environmental sensitivity) and SPACE (composed of unrefreshing sleep, pain, affective disturbances, cognitive issues, and reduced energy). Here, we perform a secondary cross-sectional analysis examining the same symptoms groups in a cohort of patients with dysmenorrhea without a diagnosis of chronic pain. Our purpose is to determine if the same symptom patterns are apparent and if they are associated with the presence and severity of comorbid pain. Participants were 201 women with dysmenorrhea. We replicated the hypothesized 2-factor structure in this cohort (comparative fit index = 0.971 and root mean square error of approximation =0.055; 90% CI: 0.000-0.097). Generalized sensory sensitivity was associated with the severity of bladder, bowel, and overall pain in multivariable models including SPACE, patient age, and BMI (all β > 0.32, all P < 0.05). Sleep, pain, affective disturbances, cognitive issues, and reduced energy were associated with menstrual pain during nonsteroidal anti-inflammatory drug use, whereas GSS was associated with the same in the absence of nonsteroidal anti-inflammatory drug use (both P < 0.05). This 2-factor model of symptoms seems to be replicable and valid in a cohort of women at risk for developing chronic pain conditions. These symptom groups are promising potential markers of future pain chronification and may point to patients in need of earlier or more aggressive intervention.
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Affiliation(s)
- Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Kevin M Hellman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Prizker School of Medicine, University Of Chicago, Chicago, IL, United States
| | - Amy M Bohnert
- Department of Psychology, Loyola University, Chicago, IL, United States
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Frank F Tu
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Prizker School of Medicine, University Of Chicago, Chicago, IL, United States
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11
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Kim HJ, Meeker TJ, Jung JY, Kim JW, Kim HA. Biological sex influences psychological aspects of the biopsychosocial model related to chronic pain intensity and interference among South Korean patients with chronic secondary musculoskeletal pain in rheumatic diseases. Front Psychol 2023; 14:1063164. [PMID: 37138999 PMCID: PMC10150094 DOI: 10.3389/fpsyg.2023.1063164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Pain is a prominent contributor to negative personal and social outcomes, including increased disability and mortality, in many rheumatic diseases. In the Biopsychosocial model of chronic pain, psychological and social factors share roles with the biology of the injury in determining each patient's pain and suffering. The current study explored factors associated with clinical pain intensity and interference among patients with chronic secondary musculoskeletal pain in rheumatic diseases. Methods In total, 220 patients experiencing chronic secondary musculoskeletal pain participated. Biological factors (age, biological sex, pain condition, pain duration, pain sensitivity, and comorbidity), socio-economic factors, psychological factors (pain catastrophizing and depressive symptoms), and pain intensity and interference were measured. Descriptive, multivariable linear regression and partial correlation analyses were conducted. Subgroup analysis by sex was conducted to examine differences in how different factors affect the pain experience. Results The mean age of the participants was 52.3 years (SD = 12.07) and ranged from 22 to 78. Average pain intensity was 3.01 (0-10 scale) and average total pain interference score was 21.07 (0-70 scale). Partial correlation found positive correlations between pain intensity and interference with depression (intensity: R = 0.224; p = 0.0011; interference: R = 0.351; p < 0.001) and pain catastrophizing (intensity: R = 0.520; p < 0.001; interference: R = 0.464; p < 0.001). In males, pain condition (β = -0.249, p = 0.032) and pain catastrophizing (R = 0.480, p < 0.001) were associated with pain intensity. In males, the simple correlation between pain intensity and depression (R = 0.519; p < 0.001) was driven by pain catastrophizing. In females, pain catastrophizing (R = 0.536, p < 0.001) and depressive symptoms (R = 0.228, p = 0.0077) were independently associated with pain intensity. Age (β = -0.251, p = 0.042) and pain catastrophizing (R = 0.609, p < 0.001) were associated with pain interference in males, while depressive symptoms (R = 0.439, p < 0.001) and pain catastrophizing (R = 0.403, p < 0.001) were associated with pain interference in females. Again, in males, the simple correlation between pain interference and depression (R = 0.455; p < 0.001) was driven by pain catastrophizing. Discussion In this study, females were more directly affected by depressive symptoms than males, regarding pain intensity and interference. Pain catastrophizing was a significant factor influencing chronic pain for both males and females. Based on these findings, a sex-specific approach to the Biopsychosocial model should be considered in understanding and managing pain among Asians with chronic secondary musculoskeletal pain.
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Affiliation(s)
- Hee Jun Kim
- School of Nursing, The George Washington University, Washington, DC, United States
- *Correspondence: Hyoun-Ah Kim,
| | - Timothy J. Meeker
- Department of Biology, Morgan State University, Baltimore, MD, United States
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon-si, Republic of Korea
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12
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Prevalence of chronic pelvic pain and primary dysmenorrhea in women of reproductive age in Ecuador. BMC Womens Health 2022; 22:363. [PMID: 36056424 PMCID: PMC9438184 DOI: 10.1186/s12905-022-01948-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chronic pelvic pain (CPP) and primary dysmenorrhoea are debilitating conditions that can impair the quality of life of affected women. These conditions are frequently neglected, delaying proper diagnosis and healthcare provision. This study aimed to estimate the prevalence of CPP and primary dysmenorrhoea in Ecuador and identify potential variables associated with their occurrence.
Methods We conducted a cross-sectional survey in an urban neighbourhood of Quito, the capital of Ecuador. A total of 2397 participants of 14–49 years of age were included. The data were collected through questionnaires administered by trained interviewers.The crude and adjusted prevalence ratios were calculated using a log-binomial regression model. The correlation between pain intensity catastrophising of symptoms were statistically analysed. Results The prevalence of CPP and primary dysmenorrhoea was 9.8% and 8.9%, respectively. Irritative urinary symptoms, primary dysmenorrhoea, and underlying mental disorders were associated with CPP, while smoking, irritable bowel syndrome, sleep disturbance, dyspareunia, and mental disorders were associated with primary dysmenorrhoea.
Conclusions The prevalence of CPP and primary dysmenorrhoea in Ecuador was similar to that in other Latin American countries. Primary dysmenorrhoea is a risk factor of CPP, and less than a quarter of women are undergoing treatment for the condition. Our findings reinforce the importance of healthcare interventions in anticipating the diagnosis of these conditions in women of reproductive age. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01948-y.
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical mechanisms of visual hypersensitivity in women at risk for chronic pelvic pain. Pain 2022; 163:1035-1048. [PMID: 34510138 PMCID: PMC8882209 DOI: 10.1097/j.pain.0000000000002469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Increased sensory sensitivity across non-nociceptive modalities is a common symptom of chronic pain conditions and is associated with chronic pain development. Providing a better understanding of the brain-behavior relationships that underlie multimodal hypersensitivity (MMH) may clarify the role of MMH in the development of chronic pain. We studied sensory hypersensitivity in a cohort of women (n = 147) who had diary confirmation of menstrual status and were enriched with risk factors for chronic pelvic pain, such as dysmenorrhea and increased bladder sensitivity. We administered 2 experimental tasks to evaluate the cross-modal relationship between visual and visceral sensitivity. Visual sensitivity was probed by presenting participants with a periodic pattern-reversal checkerboard stimulus presented across 5 brightness intensities during electroencephalography recording. Self-reported visual unpleasantness ratings for each brightness intensity were simultaneously assessed. Visceral sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visually evoked cortical activity increased with brightness intensity across the entire scalp, especially at occipital electrode sites. Visual stimulation-induced unpleasantness was associated with provoked bladder pain and evoked primary visual cortex activity. However, the relationship between unpleasantness and cortical activity was moderated by provoked bladder pain. These results demonstrate that activity in the primary visual cortex is not greater in individuals with greater visceral sensitivity. We hypothesize that downstream interpretation or integration of this signal is amplified in individuals with visceral hypersensitivity. Future studies aimed at reducing MMH in chronic pain conditions should prioritize targeting of cortical mechanisms responsible for aberrant downstream sensory integration.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L. Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E. Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E. Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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14
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Parker MA, Kent AL, Sneddon A, Wang J, Shadbolt B. The Menstrual Disorder of Teenagers (MDOT) Study No. 2: Period ImPact and Pain Assessment (PIPPA) Tool Validation in a Large Population-Based Cross-Sectional Study of Australian Teenagers. J Pediatr Adolesc Gynecol 2022; 35:30-38. [PMID: 34171477 DOI: 10.1016/j.jpag.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To validate the Period ImPact and Pain Assessment (PIPPA) self-screening tool for menstrual disturbance in teenagers. DESIGN Cross-sectional study. SETTING Three senior high schools in the Australian Capital Territory (ACT), Australia. PARTICIPANTS A total of 1066 girls between 15 and 19 years of age. INTERVENTIONS AND MAIN OUTCOME MEASURES A quantitative paper survey collected self-reports of menstrual bleeding patterns, typical and atypical symptoms, morbidities, and interference with daily activities. Multiple correspondence analysis was used to examine associations between PIPPA questions. Generalized linear models compared total score and subscores by validation criteria: pain, school absence, and body mass index (BMI). Receiver operating characteristic curves were used to evaluate the predictiveness of menstrual disturbance indicators by total PIPPA score. RESULTS Reports of pain, interference, and concern within the PIPPA items and between both the MDOT and PIPPA questionnaires were significantly correlated (P < .0001). The indicator "missing school" was highly associated (P < .0001) with pain and interference. Obesity (BMI ≥30) was associated with higher PIPPA scores, as was underweight (BMI≤18.4). Where 0 = no disturbance, 5 = high disturbance, aggregated PIPPA scores found 75% scoring 0-2 (out of 5) and 25% scoring 3-5 (257/1037). High scores of 4 or 5 (out of 5) were 7% (72/1037) and 3.7% (38/1037), respectively. CONCLUSION PIPPA is a valid screening tool for pain-related menstrual disturbance that affects functioning in young women. PIPPA subdomains of pain/interference have good validity relative to indicators of pain and interference and are responsive to age, BMI, and school absence differences.
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Affiliation(s)
- M A Parker
- Canberra Endometriosis Centre, Department of Obstetrics and Gynaecology, ACT Health, Canberra, ACT, Australia.
| | - A L Kent
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York; Australian National University, College of Health and Medicine, Canberra, ACT, Australia
| | - A Sneddon
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - J Wang
- Ocular Genomics Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - B Shadbolt
- ACT Centre for Health and Medical Research, ACT Health, Canberra, ACT, Australia
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15
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Tu FF, Hellman KM, Roth GE, Dillane KE, Walker LS. Noninvasive bladder testing of adolescent females to assess visceral hypersensitivity. Pain 2022; 163:100-109. [PMID: 34086630 PMCID: PMC8505577 DOI: 10.1097/j.pain.0000000000002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/08/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT Excess pain after visceral provocation has been suggested as a marker for chronic pelvic pain risk in women. However, few noninvasive tests have been validated that could be performed readily on youth in early risk windows. Therefore, we evaluated the validity and reliability of a noninvasive bladder pain test in 124 healthy premenarchal females (median age 11, [interquartile range 11-12]), as previously studied in adult women. We explored whether psychosocial, sensory factors, and quantitative sensory test results were associated with provoked bladder pain and assessed the relation of bladder pain with abdominal pain history. Compared with findings in young adult females (age 21 [20-28]), results were similar except that adolescents had more pain at first sensation to void (P = 0.005) and lower maximum tolerance volume (P < 0.001). Anxiety, depression, somatic symptoms, and pain catastrophizing predicted provoked bladder pain (P's < 0.05). Bladder pain inversely correlated with pressure pain thresholds (r = -0.25, P < 0.05), but not with cold pressor pain or conditioned pain modulation effectiveness. Bladder pain was also associated with frequency of abdominal pain symptoms (r = 0.25, P = 0.039). We found strong retest reliability for bladder pain at standard levels of sensory urgency in 21 adolescents who attended repeat visits at 6 to 12 months (intraclass correlations = 0.88-0.90). Noninvasive bladder pain testing seems reproducible in adolescent females and may predict abdominal pain symptomatology. Confirmation of our findings and further investigation of the bladder test across menarche will help establish how visceral sensitivity contributes to the early trajectory of pelvic pain risk.
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Affiliation(s)
- Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem Evanston, IL, United States
- Department of Ob/Gyn, University of Chicago, Pritzker School of Medicine, Chicago, IL, United States
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem Evanston, IL, United States
- Department of Ob/Gyn, University of Chicago, Pritzker School of Medicine, Chicago, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem Evanston, IL, United States
- Department of Psychology, Loyola University of Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem Evanston, IL, United States
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
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16
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Hellman KM, Oladosu FA, Garrison EF, Roth GE, Dillane KE, Tu FF. Circulating sex steroids and bladder pain sensitivity in dysmenorrhea. Mol Pain 2021; 17:17448069211035217. [PMID: 34689649 DOI: 10.1177/17448069211035217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although elevated estradiol levels facilitate chronic pelvic pain in animal models, it remains to be determined whether sex steroid levels are altered in a cross-section of women with chronic pelvic pain (CPP) and those at-risk for developing CPP. We sought to determine if sex steroid levels are increased in women with menstrual pain and whether those changes were more extreme in two groups of women with worsened pelvic pain profiles: a) dysmenorrhea plus evidence of bladder pain sensitivity and b) bladder pain syndrome. Serum samples were collected during the mid-luteal phase to measure estradiol, progesterone, testosterone, and sex hormone-binding globulin. We also compared quantitative sensory testing profiles to evaluate how sex steroid differences influence proposed pain sensitivity mechanisms. Women with combined dysmenorrhea and bladder sensitivity had higher estradiol concentrations than controls (487 [IQR 390 - 641] vs 404 [336 - 467] pmol/L, p = 0.042). Bladder pain syndrome participants had greater sex hormone-binding globulin than controls (83 [71 - 108] vs 55 [42 - 76 nmol/L; p = 0.027). Levels of pain sensitivity and mood were different across the groups, but the only significant relationship to sex steroids was that sex hormone-binding globulin was correlated to somatic symptoms (r = 0.26, p = 0.03). These findings show women potentially at-risk for CPP and women with diagnosed CPP exhibit altered circulating levels of sex steroids. Because these hormonal differences appear to be independent of mood or pain sensitivity, the role of sex steroids in the emergence of CPP may be via sensitization of visceral afferents.
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Affiliation(s)
- Kevin M Hellman
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Folabomi A Oladosu
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ellen F Garrison
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA
| | - Genevieve E Roth
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA
| | - Katlyn E Dillane
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA
| | - Frank F Tu
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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17
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Cho SH, Kim YM, Lee JH, Kim HS, Song JS. The trend of prevalence of pain in Korea from 2005 to 2016. Korean J Pain 2020; 33:352-358. [PMID: 32989200 PMCID: PMC7532288 DOI: 10.3344/kjp.2020.33.4.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Korean society is afflicted with rapid aging. Aging is a risk factor for pain, and pain can reduce patients' quality of life. Thus, adequate management and monitoring of changing trends accompanying the demographic shift are highly valuable. However, this study was conducted because no studies have investigated the recent changes in the prevalence of pain. METHODS The extent of the prevalence of pain was determined by questions related to quality of life based on the data derived from the Korea National Health and Nutrition Survey (KNHNS) from 2005 to 2016. The annual frequencies of the pain group and severe pain group were calculated using the survey questionnaire. Multiple logistic regression analysis was performed to determine possible differences in prevalence by year. RESULTS The prevalence of pain in all populations was 30.6% in 2005 and 18.9% in 2016. The average prevalence from 2005 to 2016 was 21.9%. A declining trend occurred over time with an odds ratio of 0.929 per year (95% CI: 0.921-0.938). The prevalence of severe pain was 2.35% in 2005 and 1.88% in 2016. Likewise, a decrease was observed over time, with an odds ratio of 0.920 per year at 95% CI 0.901-0.939. The decline in age-/sex-stratified analysis also showed a statistically significant trend in all groups. CONCLUSIONS The prevalence of pain in Korean society, based on the KNHNS, has declined since 2005. Such a trend was observed in all ages and sexs, and was most significant in the elderly.
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Affiliation(s)
- Sang-Hyeon Cho
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Yong-Min Kim
- Department of Chemical and Biological Engineering, College of Engineering, Seoul National University, Seoul, Korea
| | - Jae-Ho Lee
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Hyun-Soo Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Jae-Seok Song
- Department of Preventive Medicine, Catholic Kwandong University College of Medicine, Gangneung, Korea
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