Riley Joseph L, Robinson Michael E, Wise Emily A, Price Donald
Claude Pepper Center for Research of Oral Health in Aging, College of Dentistry, University of Florida, Gainesville, FL, USA Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, USA.
Pain. 1999 Jun;81(3):225-235. doi: 10.1016/S0304-3959(98)00258-9.
The purpose of this article is to review the sixteen published studies that examine associations between the perception of experimentally induced pain across menstrual cycle phases of healthy females. We also performed a meta-analysis to quantitatively analyze the data and attempt to draw conclusions. The results suggest that there are relatively consistent patterns in the sensitivity to painful stimulation. These patterns are similar across stimulus modality with the exception of electrical stimulation. The magnitude of the effect was approximately 0.40 across all stimulation. For pressure stimulation, cold pressor pain, thermal heat stimulation, and ischemic muscle pain, a clear pattern emerges with the follicular phase demonstrating higher thresholds than later phases. When the effect size was pooled across studies (excluding electrical) comparisons involving the follicular phase were small to moderate (periovulatory phase, d(thr) = 0.34; luteal phase, d(thr) = 0.37; premenstrual phase, d(thr) = 0.48). The pattern of effects was similar for tolerance measures. Electrical stimulation was different than the other stimulus modalities, showing the highest thresholds for the luteal phase. When the effect size was pooled across studies for electrical stimulation, effect sizes were small to moderate (menstrual (d(thr) = -0.37), follicular d(thr) = -0.30) periovulatory d(thr) = -0.61), and premenstrual d(thr) = 0.35) phases. This paper raises several important questions, which are yet to be answered. How much and in what way does this menstrual cycle effect bias studies of female subjects participating in clinical trials? Furthermore, how should studies of clinical pain samples control for menstrual related differences in pain ratings and do they exist in clinical pain syndromes? What this paper does suggest is that the menstrual cycle effect on human pain perception is too large to ignore.
本文的目的是回顾16项已发表的研究,这些研究探讨了健康女性在月经周期各阶段对实验性诱发疼痛的感知之间的关联。我们还进行了荟萃分析以定量分析数据并试图得出结论。结果表明,对疼痛刺激的敏感性存在相对一致的模式。除电刺激外,这些模式在不同刺激方式中相似。所有刺激的效应大小约为0.40。对于压力刺激、冷加压疼痛、热刺激和缺血性肌肉疼痛,出现了一种明显的模式,即卵泡期的阈值高于后期阶段。当汇总各研究(不包括电刺激)的效应大小时,涉及卵泡期的比较为小到中等效应(排卵期,d(thr)=0.34;黄体期,d(thr)=0.37;经前期,d(thr)=0.48)。耐受性测量的效应模式相似。电刺激与其他刺激方式不同,黄体期的阈值最高。当汇总各研究电刺激的效应大小时,效应大小为小到中等(月经期(d(thr)=-0.37),卵泡期d(thr)=-0.30),排卵期d(thr)=-0.61),经前期d(thr)=0.35)阶段)。本文提出了几个重要问题,尚待解答。这种月经周期效应在多大程度上以及以何种方式会影响参与临床试验的女性受试者的研究?此外,临床疼痛样本的研究应如何控制与月经相关的疼痛评分差异,以及这些差异是否存在于临床疼痛综合征中?本文确实表明的是,月经周期对人类疼痛感知的影响太大,不容忽视。
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