Nondysmenorrheic Women Research Articles

Comparative study of response to experimental cold pain in dysmenorrheic and nondysmenorrheic women

Background: There has been keen research interest into the gender differences in tolerance of pain sensation. Dysmenorrheic pain is common among women of reproductive age group. Assessment of pain perception will result in better management of this chronic state. In this era of personalized medicine, optimizing analgesic treatment in patients with chronic pain is essential. Aims and Objectives: To compare levels of pain threshold and pain tolerance determined using cold pressor test in dysmenorrheic and nondysmenorrheic women during a single menstrual cycle in different phases. Materials and Methods: This is a comparative study done on 31 dysmenorrheic and nondysmenorrheic women between the ages of 18 and 22 years conducted in a tertiary care institution. We performed cold pressor test on 1st, 14th, and 21st day of menstrual cycle denoting the menstrual phase, late follicular phase, and luteal phase on the participants. Results: The levels of pain tolerance and pain threshold were significantly higher in dysmenorrheic women in comparison to nondysmenorrheic women. Conclusions: Higher thresholds may be supportive of a model of pain adaptation as dysmenorrheic women tend to compare cold pressor pain with internal menstrual pain. The knowledge of varying pain perception would benefit the gynecologists in dose adjustments of analgesics.

Specific Physiological Responses in Women with Severe Primary Dysmenorrhea during the Menstrual Cycle

This study examined the specific physiological responses of women with primary dysmenorrhea during the severely painful menstrual (days 1-2 of menstruation) and the non-painful follicular phases (days 5-8 after the onset of menstruation). Subjects consisted of 10 severe primary dysmenorrheic (Group P) and 10 non-dysmenorrheic women (Group C) with regular menstrual cycles. However, only 9 out of 10 and 8 out of 10 subjects of Groups P and C participated during the follicular phase. Physiological measures were taken in a resting state for 60 min. In the menstrual phase, the pain ratings and secretory immunoglobulin A (s-IgA) concentrations of Group P were significantly higher than those of Group C, with relatively significant decreases in the leg-skin temperature in the former as well. In addition, the systolic (SBP) and diastolic blood pressure (DBP) at 45 min after rest in Group P were significantly higher than those found in Group C. These reactions strongly suggest activation of the sympathetic-adrenal-medullary axis (SAM axis) by painful stress. Furthermore, the low-frequency (LF) component of the SBP variability (SBPV) was significantly higher in Group P than Group C, even during the follicular phase. These findings imply that Group P may well have elevated activities of the SAM axis throughout the whole menstrual cycle. As such, it suggests that dysmenorrheic women may be affected by certain stressors other than pain per se and pain-derived emotions throughout the whole menstrual cycle. The findings also indicate that women with dysmenorrhea have more sensitive responses to the SAM system than non-dysmenorrheic women during stress. Moreover, the high-frequency (HF) component of heart rate variability (HRV), or the index for the vagus nerve activity, displayed a consistently higher value in Group P than C. It is postulated that the human body may have responded to pain in an attempt to maintain the homeostatic state by enhancing vagus nerve activity.

Pain Perception in Women With Dysmenorrhea

In Brief OBJECTIVE To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS Twenty-two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra-threshold magnitude estimation to heat stimuli, pain-evoked potentials by laser stimuli, and anxiety scores four times across their menstrual cycles. RESULTS Significant differences were found between dysmenorrheic and nondysmenorrheic women. In all four examinations across the menstrual cycle, dysmenorrheic women had longer latencies of pain-evoked potentials (383.08 ± 6.8 msec versus 345.05 ± 7.0 msec, P < .001), higher magnitude estimations on visual analog scale of supra-threshold pain (83.29 ± 2.87 versus 63.50 ± 3.82, P < .001), and higher state anxiety scores (37.69 ± 1.7 versus 29.20 ± 1.9, P = .002). CONCLUSION Women with dysmenorrhea show enhanced pain perception compared to nondysmenorrheic women. This augmentation of pain perception may be part of the development of dysmenorrhea. Women with dysmenorrhea have increased systemic pain perception across the menstrual cycle.

Pain perception in women with dysmenorrhea

OBJECTIVE: To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS: Twenty-two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra-threshold magnitude estimation to heat stimuli, pain-evoked potentials by laser stimuli, and anxiety scores four times across their menstrual cycles. RESULTS: Significant differences were found between dysmenorrheic and nondysmenorrheic women. In all four examinations across the menstrual cycle, dysmenorrheic women had longer latencies of pain-evoked potentials (383.08 ± 6.8 msec versus 345.05 ± 7.0 msec, P < .001), higher magnitude estimations on visual analog scale of supra-threshold pain (83.29 ± 2.87 versus 63.50 ± 3.82, P < .001), and higher state anxiety scores (37.69 ± 1.7 versus 29.20 ± 1.9, P = .002). CONCLUSION: Women with dysmenorrhea show enhanced pain perception compared to nondysmenorrheic women. This augmentation of pain perception may be part of the development of dysmenorrhea.

Modulation of pain and hyperalgesia from the urinary tract by algogenic conditions of the reproductive organs in women

This study investigated the impact of algogenic conditions of the reproductive organs upon urinary pain perception in women. A 5-year survey was conducted among 69 fertile women with calculosis of one upper urinary tract via an ad-hoc questionnaire. At both retrospective (3 years) and prospective (2 years) investigation, dysmenorrheic women (D) reported more colics than non-dysmenorrheic women (ND) ( P<0.001) and women with previous dysmenorrhea treated with estroprogestins (DH)( P<0.05). Pain thresholds (electrical stimulation) of the oblique musculature ipsilateral to the stone (L1, site of referred hyperalgesia from upper urinary tract) were lower in D than in ND ( P<0.01) and DH ( P<0.05). Calculosis women with asymptomatic endometriosis / ovarian cysts also reported more colics (6-month prospective study) and greater threshold lowering ( P<0.05) than women with calculosis alone. The results show enhancement of urinary pain / hyperalgesia by both manifest and latent algogenic conditions of the female reproductive organs. This enhancement could derive from neuronal sensitization in spinal segments of common projection of the two visceral districts (T10-L1).

Pain threshold variations in somatic wall tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmenorrheic women, dysmenorrheic women and men

Pain symptoms of many disorders are reported to vary with menstrual stage. This study investigated how pain thresholds to electrical stimulation of the skin, subcutis and muscle tissue varied with menstrual stage in normal women and compared these variations with those in women with dysmenorrhea and in healthy men at matched intervals. Thresholds of the three tissues were measured four times during the course of one menstrual cycle at four sites. Two of the sites were on the abdomen within the uterine viscerotome (abdomen-rectus abdominis, left and right) and two were outside it on the limbs (leg-quadriceps, arm-deltoid). Calculated from the beginning of menstruation (day 0), the menstrual phases studied were menstrual (days 2–6), periovulatory (days 12–16), luteal (days 17–22) and premenstrual (days 25–28). Spontaneous pain associated with menstruation was measured from diary estimates on a VAS scale. Menstrual phase, dysmenorrhea and tissue: Whereas the highest thresholds always occurred in the luteal phase regardless of segmental site or stimulus depth, the lowest thresholds occurred in the periovulatory stage for skin, whereas those for muscle/subcutis occurred perimenstrually. Dysmenorrhea accentuated the impact of menstrual phase. For non-dysmenorrheic women menstrual trends were significant only in abdominal muscle and subcutis, but for dysmenorrheic women the trends were also significant in abdominal skin and in limb muscle and subcutis. Dysmenorrhea also lowered thresholds mainly in muscle and sometimes in subcutis, but never in skin, with the greatest hyperalgesic effects in left abdominis muscle. Segmental site: Abdominal sites were more vulnerable to menstrual influences than limb sites. Muscle thresholds, but not skin or subcutis thresholds, were significantly lower in abdomen than in limbs, particularly in dysmenorrheic women. The amount of abdominal muscle hyperalgesia correlated significantly with the amount of spontaneous menstrual pain. Sex differences: Only minor sex differences were observed for pain thresholds of the arm and leg, but there was a unanimous refusal by men, but not by women, to be tested at abdominal sites. These results indicate that menstrual phase, dysmenorrhea status, segmental site, tissue depth and sex all have unique interacting effects on pain thresholds, thus adding more items to the lengthy and still-growing list of biological factors that enter into an individual's judgment of whether or not a stimulus is painful.

GI Symptoms, Function, and Psychophysiological Arousal In Dysmenorrheic Women

In a previous study, gastrointestinal (GI) symptoms and stool characteristics were found to be influenced by menstrual cycle phase. The current study was designed to replicate initial work regarding GI symptoms and stool characteristics and to explore the relationships between GI symptoms, stool characteristics, ovarian hormone levels, and indicators of psychophysiological arousal. Fifty women (dysmenorrheic, N = 22; nondysmenorrheic, N = 28) maintained a daily dairy for recording stool characteristics, GI symptoms, and daily anxiety level. First morning void urine specimens for catecholamine assays and serum samples for ovarian hormone and cortisol determinations were obtained at menses, follicular, and luteal phases. Results showed menstrual cycle-related differences in stool characteristics and report of GI symptoms, with the greatest changes occurring at menses in the total sample. Dysmenorrheic women reported higher levels of all GI symptoms at menses as compared to nondysmenorrheic women. In addition, cycle-related differences in serum cortisol, urine catecholamines, and report of anxiety were also noted, particularly in dysmenorrheic women. However, looser stools and GI symptoms at menses were not correlated with absolute levels of ovarian hormones or indicators of psychophysiological arousal.

Reactions of dysmenorrheic and nondysmenorrheic women to experimentally induced pain throughout the menstrual cycle.

It has been proposed that dysmenorrheic women have a heightened pain sensitivity compared to nondysmenorrheic women, although previous studies investigating this hypothesis have yielded conflicting results. This study investigated the pain sensitivity of nondysmenorrheic women and of women suffering from spasmodic, congestive, and combined dysmenorrhea, across three phases of the menstrual cycle: premenstrual, menstrual, and intermenstrual. No interaction between type of dysmenorrhea and menstrual phase was found for either pain threshold or pain tolerance, using three procedures of experimentally induced pain. On a self-report measure of pain, however, the congestive and combined dysmenorrheics reported the highest degree of pain and distress, especially during the premenstrual and menstrual phases; nonsufferers reported the lowest degree and were stable across phases.

Sensitivity to cold pressor pain in dysmenorrheic and non-dysmenorrheic women as a function of menstrual cycle phase

Pain responses (threshold, tolerance, and visual analog ratings) to the cold pressor task were studied in 46 normally menstruating dysmenorrheic and non-dysmenorrheic women during 2 phases of the menstrual cycle. Twenty-six women provided measurements during the follicular (days 8–14) and 20 during the luteal (days 15–21) phases of the menstrual cycle. A significantly lower pain threshold was obtained during the luteal as compared to the follicular phase. Pain tolerance showed a similar but non-significant trend. Visual analog ratings were significantly lower in dysmenorrheic women during the follicular than the luteal phase. Also, these ratings were lower than those of non-dysmenorrheic women in the follicular phase. This finding may support an adaptation-levels model, in that dysmenorrheic women report less pain than do non-dysmenorrheic women because they compare cold pressor pain with internal menstrual pain.

Stress responsivity among dysmenorrheic women at different phases of their menstrual cycle: More ado about nothing

Dysmenorrheic and nondysmenorrheic women in the follicular, luteal and menstrual phase of their menstrual cycle participated in a stressful laboratory procedure. Pulse rate, pulse volume and skin conductance were measured continuously during baseline, during confrontation of three stressful tasks (i.e. stress-reactivity periods) and following each confrontation (i.e. stress-recovery periods). The hypothesis that dysmenorrheic Ss in the menstrual phase of their cycle would show greater stress responsitivity was generally not confirmed, and the broader contention that women differ in their stress responsivity as a function of their menstrual cycle phase was shown to be of questionable validity.

An ROC analysis of pain reactions in dysmenorrheic and nondysmenorrheic women.

Reactions to radiant heat stimuli were measured in dysmenorrheic and nondysmenorrheic women across a 4-week period. (Dysmenorrhea is a condition in which pain accompanies menstruation.) Receiver operating characteristic (ROC) curve parameters were computed for each of the phases of the menstrual cycle. When painful stimuli were used, a group × phase interaction was found in the analysis on the d’e scores. Nondysmenorrheic women were found to vary cyclically in their ability to discriminate painful from nonpainful stimuli, whereas dysmenorrheic women showed consistent pain reactions throughout the whole cycle. Cyclic effects were not apparent in the analyses on the response criteria or in those on reactions to thermal stimuli. The results suggest that women who experience pain with menstruation differ from women who do not differ in their perception of pain across the menstrual cycle. The sensory differences between the groups of women were not characteristic of responses to thermal stimuli and were not accompanied by shifts in willingness to report pain. Biochemical differences between dysmenorrheic and nondysmenorrheic women are believed to be the cause of the differences in pain reactions across phase.

Pain sensitivity and coping strategies among dysmenorrheic women: Much ado about nothing

Samples of spasmodic, congestive and combined dysmenorrheic women and non-dysmenorrheic women were subjected to an ischemic pain procedure to measure their pain threshold, pain tolerance and self-reported pain. Cognitive and behavioral strategies that subjects had spontaneously used during the pain procedure were later assessed. A classification system was derived for categorizing subjects' responses to the interview and questionnaire used in this assessment. Contrary to previous claims that dysmenorrheic women may be hypersensitive to pain, no differences in pain sensitivity were discovered among the four groups of subjects. A few differences in cognitive and behavioral strategies did emerge, but these were of insufficient magnitude to contend that dysmenorrheic women are disadvantaged in their strategies for coping with pain.

Endogenous prostaglandins in dysmenorrhea and the effect of prostaglandin synthetase inhibitors (PGSI) on uterine contractility.

The plasma concentration of 13,14-dihydro-PGF2 alpha during menstruation were determined by gas chromatography in 6 non-dysmenorrheic and 10 dysmenorrheic women. Nine out of 10 dysmenorrheic women were found to have increased levels (greater than 50 pg/ml) of the metabolite compared with mean level 25 pg/ml for non-dysmenorrheic women. All 9 women with elevated PGF2 alpha-metabolite levels responded favourably to treatment of dysmenorrhea with prostaglandin synthetase inhibitors. Determinations of PGF2 alpha in the endometrium carried out by gas chromatography-mass spectrometry showed 4 times higher concentrations in 5 dysmenorrheic women compared with 5 non-dysmenorrheic subjects. Treatment of dysmenorrhea with placebo or naproxen 250 mg and 500 mg in 6 patients resulted in decrease in tonus and amplitude of the contractions with a more rapid effect following administration of naproxen 500 mg while no effect was seen in 5 out of 6 patients following administration of placebo.