Pain Catastrophizing Predicts Menstrual Pain Ratings in Adolescent Girls with Chronic Pain

A comprehensive investigation of biopsychosocial determinants influencing primary dysmenorrhea among university students

Dysmenorrhea, characterized by pain and related symptoms, significantly impacts women's quality of life in work and education, prompting a comprehensive evaluation of associated factors. The objective of this study was to utilize structural equation modeling (SEM) to analyze and assess the biopsychosocial factors influencing dysmenorrhea among university students. Three hundred and thirty-nine university students were included in this cross-sectional descriptive study. Data were collected using the Participant Information Form, the Beck Anxiety Scale (BAS), the Beck Depression Scale (BDS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Adverse Childhood Experiences Scale (ACES), the Pain Catastrophizing Scale (PCS) and the Visual Analogue Scale (VAS). It was determined that the variables of pain onset (t = 3.24, p < .05) and age at menarche (t = -2.16, p < .05) showed a significant relationship with the model. The variables of the PCS (t = 16.87, p < .001), BDS (t = 3.06, p < .05), and BAS (t = 5.13, p < .001) showed a significant relationship with the model. Social factors in the model were examined, and a family history of dysmenorrhea and the ACES variables did not contribute significantly to the model (p > .05). The study indicates primary dysmenorrhea influenced by biological and psychological factors. Nurses should conduct holistic assessments and provide comprehensive care for affected women.

Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models

Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.

Dysmenorrhea catastrophizing and functional impairment in female pelvic pain

Background

Dysmenorrhea is suggested to increase the risk of chronic pain by enhancing central sensitization. However, little is known about whether emotional and cognitive responses induced by dysmenorrhea contribute to chronic pain interference. This study examined the association between catastrophizing specific to dysmenorrhea and both dysmenorrhea and chronic pelvic pain (CPP)-associated pain interference.

Methods

Women (N = 104) receiving care for CPP through a tertiary gynecological pain clinic between 2017 and 2020 were recruited. They completed the Pain Catastrophizing Scale, the Brief Pain Inventory-pain interference, and a separate questionnaire regarding dysmenorrhea symptoms and treatment preceding the development of CPP. Dysmenorrhea catastrophizing and interference measures were developed and tested for internal consistency and construct validity. Multiple linear regression models examined dysmenorrhea catastrophizing in association with dysmenorrhea interference and CPP-associated pain interference.

Results

Dysmenorrhea catastrophizing and interference measures demonstrated excellent internal consistency (Cronbach's Alpha = 0.93 and 0.92 respectively) and evidence of construct validity (correlated with dysmenorrhea severity and treatment, Ps < 0.01). Dysmenorrhea catastrophizing was moderately correlated with pain catastrophizing (ρ = 0.30, P = 0.003), and was associated with greater dysmenorrhea interference (P < 0.001) and CPP-associated pain interference (P = 0.032) accounting for general pain catastrophizing and other outcome-specific confounders. Dysmenorrhea intensity was most predictive of dysmenorrhea catastrophizing.

Conclusion

Among our clinical sample of women with CPP, dysmenorrhea catastrophizing was associated with greater dysmenorrhea interference and subsequent CPP-associated pain interference. More research is needed to determine whether reduction in dysmenorrhea catastrophizing leads to reduced pain interference associated with female pelvic pain.

Pain catastrophizing is associated with pain thresholds for heat, cold and pressure in women with chronic pelvic pain

Background and aims Psychological traits such as pain catastrophizing may play a role in the development of chronic pelvic pain (CPP). Pain catastrophizing is the tendency to amplify negative cognitive and emotional pain processes. The Pain Catastrophizing Scale (PCS) assesses elements of pain catastrophizing divided into three subgroups of factors (rumination, helplessness and magnification). Previous studies have shown associations between CPP and increased pain sensitivity, widespread generalized hyperalgesia, and decreased pain thresholds, but the relation between pain catastrophizing and specific pain thresholds has not yet been widely examined in this patient group. The aims of this study were (a) to determine if catastrophizing is increased in women with CPP compared with pain-free women, (b) to assess the importance of pain catastrophizing, psychological distress variables, and subjective pain sensitivity for pain thresholds of heat, cold and pressure in these two groups, and (c) to determine whether psychological variables or pain thresholds best contribute to the differentiation between CPP and controls. Methods Thirty-seven women with chronic pelvic pain who underwent diagnostic laparoscopy on the suspicion of endometriosis participated along with 55 healthy and pain-free controls. All underwent quantitative sensory testing on six locations on the body to determine heat (HPT), cold (CPT) and pressure (PPT) pain thresholds. The PCS, the Pain Sensitivity Questionnaire (PSQ), the Hospital Anxiety Depression Scale, (HADS) demographics and clinical data were collected prospectively. Principal component analysis and orthogonal partial least square regressions were used to assess the associations between PCS scores and pain thresholds. Results The women with CPP scored significantly higher on PCS than the healthy controls. PCS-helplessness, PCS-rumination and HADS-depression were significantly associated with pain thresholds for the whole group. In the CPP group, PCS-rumination, body mass index and PSQ were significant regressors for HPT and CPT. The PCS and the HADS subscales were strongly intercorrelated in women with CPP and were stronger regressors of group membership than the three pain thresholds. In the group of healthy control women, no relationships were found to be significant. The psychological variables were somewhat stronger significant regressors than pain thresholds (also significant) for group membership. Conclusions Women with CPP have significantly higher pain catastrophizing scores than women without CPP. The pain catastrophizing rumination factor is significantly associated with pain thresholds of heat and cold in CPP women. PCS and HADS are strongly intercorrelated and PSQ correlates positively with these variables. It seems that the psychological variables are important for group differentiation. Implications The results clearly indicate the need for a multimodal assessment (bio-psycho-social) of CPP patients including psychological symptoms such as catastrophizing, anxiety and depression. The registration of semi-objective pain thresholds captures both specific pain sensitivity information (mechanical pressure, cold or heat) and the degree of wide spread pain hypersensitivity. There is a need for future larger studies investigating whether certain profiles in the clinical presentations (including pain thresholds and psychological variables) are associated with outcomes after different types of interventions.

Integrating Lifestyle Focused Approaches into the Management of Primary Dysmenorrhea: Impact on Quality of Life

OBJECTIVE

This narrative review aims to identify alternative ways to improve the symptoms of primary dysmenorrhea (PD).

BACKGROUND

PD refers to endometrial painful cramps during the premenstrual period. This condition affects a lot of women worldwide and is accompanied with absenteeism and high economic costs, thus, risk-free, and effective therapeutic approaches are needed. Pharmacological agents such as non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which are widely prescribed for these women, demonstrate adequate efficacy in alleviating pain and discomfort. The long natural course of the disease dictates remedies that focus on lifestyle changes and on improvement of Quality-of-Life (QoL) for women suffering with PD.

MATERIALS AND METHODS

Five major search engines, namely MEDLINE, PubMed, EMBASE, and Cochrane Library were searched for articles published prior to October 2020 focused in PD. A total of 74 paper were included.

DISCUSSION

Physical activity, for instance yoga, aromatherapy massage, and other forms of relaxation, vitamins and dietary changes, acupressure and acupuncture,a and some psychological interventions are just few of the proposed health behavior targeted approaches in cases of PD. This review focuses on lifestyle changes and alternative methods that could potentially result in minimizing symptoms of PD and in improving overall QoL for these patients, by providing current scientific evidence on their efficacy.

CONCLUSION

Complementary and alternative medicine practices (CAM) are widely accepted by women. International literature provides controversial scientific evidence, thus further studies need to be conducted in order to prove or disregard their efficacy in cases of PD.

Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study

BACKGROUND

Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment.

OBJECTIVES

The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals' phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics.

METHODS

This cross-sectional survey study included 678 women (aged 14-42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals' phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics.

RESULTS

We reproduced three dysmenorrhea symptom-based phenotypes: the "mild localized pain" phenotype (characterized by mild abdominal cramps), the "severe localized pain" phenotype (characterized by severe abdominal cramps), and the "multiple severe symptoms" phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals' phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes.

DISCUSSION

Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.

Parental Bonding in Adolescents With and Without Chronic Pain

Objective

Parental responses influence children's pain; however, the specific role of parental bonding in pediatric pain has not been examined. Depressive symptomology is frequently reported in children with chronic pain (CP) and may play a role in the relationship between parental bonding and pain. This study examined the connections between maternal/paternal bonding (perceived care and control) and symptoms of pain and depression in adolescents with CP and in healthy adolescents.

Method

Participants included 116 adolescents (aged 12-17) with CP (n = 55) and without (n = 61). Adolescents completed the Parental Bonding Instrument separately for their mother and father, as well as measures of depression and pain.

Results

Significant associations between parental bonding and adolescent pain and depression emerged in the pain group, but not in the healthy group. There were no differences in the impact of maternal versus paternal bonding on adolescent pain and depression. Mediation analyses revealed adolescent depression was a mediator of the relationship between maternal care and adolescent pain, and paternal control and adolescent pain in the group with CP.

Conclusions

This study highlights the importance of considering parental bonding and adolescent depression in pediatric CP, suggesting that high paternal control and low maternal care contribute to increased pain in adolescents through heightened adolescent depressive symptoms. The findings emphasize the need for family-based treatment for CP that addresses parent behaviors and adolescent mental health.

Prevalence, Wellbeing, and Symptoms of Dysmenorrhea among University Nursing Students in Greece

Dysmenorrhea (pain during menstruation) is one of the most common medical conditions among women of reproductive age. Dysmenorrhea has been studied around the world but not yet in Greece. The aim of the present study was to investigate the prevalence, characteristics, and impact of dysmenorrhea on the wellbeing (exercising, and social and academic functioning) among nursing students in Greece. A cross-sectional study of 637 nursing students was conducted by administering a questionnaire at a university in Athens. The prevalence of dysmenorrhea was 89.2% and the rate of severe intensity was 52.5%. Factors that were associated with severe dysmenorrhea were family history (p = 0.02), early menarche (p = 0.05) and menstruation duration (p = 0.05). Women with moderate and severe pain reported using pain relievers (non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol etc., p < 0.0005). Finally, activities affected by severe pain were class attendance (p = 0.01), personal studying (p < 0.0005), exercising (p < 0.0005), and socializing (p < 0.0005). Exam attendance (p = 0.27) and clinical placement attendance (p = 0.48) were not affected by severe dysmenorrhea. Dysmenorrhea has a high prevalence among nursing students and seems to affect important aspects of wellbeing and academic performance when the pain intensity is severe. The present findings lay the foundation for further investigation of dysmenorrhea both in the Greek population and cross-culturally.

Pain, Pain Catastrophizing, and Individual Differences in Executive Function in Adolescence

Many adolescents will experience pain at some point in their development that can lead to poor quality of life. The largest risk factor for pain is tendencies to magnify and ruminate on pain, known as pain catastrophizing. One mechanism of catastrophizing may be difficulties with executive function, or the ability to cognitively control information. The objective of the current study was to determine if adolescent executive function difficulties relate to high catastrophizing and pain. Fifty adolescents completed measures of pain, pain catastrophizing, and executive function. Path models revealed relations among gender, executive function domains, pain catastrophizing domains, and pain. In general, pain catastrophizing was associated with problems with shifting and inhibition. Females reported high catastrophizing and pain, partially explained by executive function difficulty. Executive function difficulty may help clinicians identify adolescents prone to catastrophize painful events. Interventions addressing these difficulties may reduce catastrophizing as well as pain intensity and duration.

Influencing factors of dysmenorrhoea among hospital nurses: a questionnaire survey in Taiwan

OBJECTIVES

Nurses are at high risk of dysmenorrhoea while working with patients. The study objectives were to: (1) describe the demographic and menstruation characteristics of dysmenorrhoea, knowledge about dysmenorrhoea and menstrual attitudes towards menstruation among dysmenorrhoeal and non-dysmenorrhoeal hospital nurses; (2) identify significant differences between the groups; and (3) examine factors influencing dysmenorrhoea.

METHODS

This cross-sectional survey used a structured questionnaire, administered at two hospitals in southern Taiwan. Participants included hospital nurses at least 18 years of age who agreed to participate. All participants were recruited through random sampling. The questionnaire included demographic data, the Dysmenorrhoea Knowledge Scale and Menstrual Attitude Scale (MAS).

RESULTS

A total of 420 nurses completed the questionnaire. Among them, 297 (70.7%) had experienced dysmenorrhoea in the past 6 months and 123 (29.3%) had not. Significant differences in age (P<0.001), marital status (P<0.001), childbearing status (P<0.001), age at menarche (P<0.05) and rotating three shift ratio (P<0.05) were identified between the dysmenorrhoea and non-dysmenorrhoea groups. Analysis of the MAS results revealed significant differences between the groups regarding consideration of menstruation as a debilitating (P<0.001) or bothersome event (P<0.05), anticipation and prediction of menstruation onset (P<0.01) and denial of any effects from menstruation (P<0.001). Results of the multiple logistic regression showed that predictive factors included age <40 years (4.46 vs 1.00), working three shift rotations (2.07 vs 1.00), marital status (2.59 vs 1.00), acknowledging menstruation as a debilitating event (2.72 vs 1.00) and denial of effects from menstruation (2.59 vs 1.00).

CONCLUSIONS

These findings could help nursing managers to create a caring and friendly work environment for hospital nurses at risk of dysmenorrhoea.

Chronic Pelvic Pain: Assessment, Evaluation, and Objectivation

Chronic Pelvic Pain (CPP) and Chronic Pelvic Pain Syndrome (CPPS) have a significant impact on men and women of reproductive and nonreproductive age, with a considerable burden on overall quality of life (QoL) and on psychological, functional, and behavioural status. Moreover, diagnostic and therapeutic difficulties are remarkable features in many patients. Therefore evaluation, assessment and objectivation tools are often necessary to properly address each patient and consequently his/her clinical needs. Here we review the different tools for pain assessment, evaluation, and objectivation; specific features regarding CPP/CPPS will be highlighted. Also, recent findings disclosed with neuroimaging investigations will be reviewed as they provide new insights into CPP/CPPS pathophysiology and may serve as a tool for CPP assessment and objectivation.

Experimental and procedural pain responses in primary dysmenorrhea: a systematic review

Primary dysmenorrhea (PD) has been the focus of a number of experimental pain studies. Although a number of reviews exist, few have critically evaluated the existing body of research on PD and experimental and procedural pain. Data from 19 published research articles that include women with PD and responses to an experimental or procedural pain stimulus (or stimuli) suggest that women with PD may have elevated pain reactivity, as compared to women without PD. This pattern appears to be true across different phases of the menstrual cycle. However, there is an abundance of conflicting findings, which may be due to significant methodological issues such as inconsistent definitions of PD, wide variation in experimental pain methodologies, and inaccurate assessment of the menstrual cycle. Future research should focus on identifying specific symptoms (i.e., pain threshold ratings) to more clearly define what constitutes PD, establish reliable and valid laboratory testing protocols, and assess the menstrual cycle with greater precision.