Department of Dental Medicine, Section for Orofacial Pain and Jaw Function, Karolinska Institutet, Huddinge, Sweden.
J Pain. 2012 Jul;13(7):646-55. doi: 10.1016/j.jpain.2012.04.002. Epub 2012 May 26.
UNLABELLED: This study investigated if conditioned pain modulation (CPM) varies across the menstrual cycle in healthy, normally menstruating women and investigated correlations between sex hormone levels and CPM across the menstrual cycle. Thirty-six normally menstruating women were tested during 3 phases of the menstrual cycle: early follicular, ovulatory, and midluteal, confirmed by hormone determinations. Mechanical pressure (test stimulus) was applied to the masseter muscle and the induced pain assessed before, during, and after immersion of the hand into ice water (conditioning stimulus) to activate CPM or tepid water (control). Conditioning pain, ie, pain in the hand during CPM/control experiment, and tolerance time were also measured. Test pain intensity was suppressed during CPM in all phases (P < .001), but with more effective suppression during the ovulatry than during the early follicular phase (P < .05). There were no changes in test pain intensity during the control experiment and no significant differences in conditioning pain, or tolerance time between phases. In conclusion, our results showed more effective pain modulation in the ovulatory phase of the menstrual cycle, when estradiol levels are high and progesterone levels are low, than in the early follicular phase when both these hormones are low. PERSPECTIVE: Deficient pain modulation is believed to be an important pathogenic factor in many chronic pain conditions that affect women. This article shows that sex hormones modulate conditioned pain modulation, because pain inhibition was more effective in the ovulatory phase of the menstrual cycle than in the early follicular phase.
本研究旨在探究在健康、正常月经周期的女性中,条件性疼痛调制(CPM)是否会随月经周期而变化,并探讨性激素水平与整个月经周期 CPM 之间的相关性。36 名正常月经周期的女性在月经周期的 3 个阶段接受测试:卵泡早期、排卵和黄体中期,通过激素测定确认。机械压力(测试刺激)施加于咀嚼肌,评估手浸入冰水(条件刺激)或温水(对照)前后引起的疼痛,以激活 CPM 或 tepid 水(对照)。还测量了条件性疼痛,即 CPM/对照实验中手的疼痛,以及耐受时间。在所有阶段,CPM 都能抑制测试疼痛强度(P<0.001),但排卵阶段的抑制效果优于卵泡早期(P<0.05)。对照实验中测试疼痛强度没有变化,各阶段的条件性疼痛或耐受时间也没有显著差异。总之,我们的研究结果表明,在月经周期的排卵阶段,当雌激素水平高而孕激素水平低时,疼痛调制更为有效,而在雌激素和孕激素水平均低的卵泡早期则不然。
观点:人们认为,疼痛调制不足是影响女性的许多慢性疼痛疾病的一个重要致病因素。本文表明,性激素调节条件性疼痛调制,因为在月经周期的排卵阶段,疼痛抑制效果比卵泡早期更为显著。
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