Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Pain. 2013 Nov;14(11):1349-60. doi: 10.1016/j.jpain.2013.05.014. Epub 2013 Aug 17.
Somatic symptoms experienced by women with a menstrually related mood disorder (MRMD) during their premenstrual luteal phase contribute to functional impairment. Yet, investigations on pathophysiological mechanisms contributing to heightened pain sensitivity in MRMD are sparse. During the luteal phase, 61 women with an MRMD and 61 non-MRMD controls were evaluated for β-adrenergic receptor (β-AR) responsivity using the isoproterenol sensitivity test. A subset (43 MRMD and 50 non-MRMD) then entered a double-blind, placebo-controlled, crossover protocol to examine the effect of β-AR blockade with intravenous propranolol on sensitivity to experimental (cold pressor and ischemic) and clinical (McGill Pain Questionnaire score) pain. Women with an MRMD exhibited greater β1- and β2-AR responsivity, ischemic pain intensity, and affective clinical pain ratings than controls. Propranolol increased cold pressor pain tolerance in both groups, but it decreased cold pain intensity and ischemic pain unpleasantness ratings only in non-MRMD women. In contrast, propranolol decreased affective ratings of clinical pain in women with MRMD. Exploratory analyses indicated that only in MRMD women did greater β-AR responsivity predict greater sensitivity to cold pressor and ischemic pain. This study provides the first evidence for a role of β-AR mechanisms in the hyperalgesia and clinical pain experienced by women with MRMDs.
This article describes the effects of β-adrenergic receptor stimulation and blockade on experimental and clinical pain sensitivity in women with an MRMD. The results of this study may have implications for the management of the substantial somatic premenstrual symptomatology experienced by women with an MRMD.
患有经前期情绪障碍（MRMD）的女性在经前期黄体期经历的躯体症状会导致功能障碍。然而，关于导致 MRMD 中疼痛敏感性增加的病理生理机制的研究还很稀少。在黄体期，对 61 名患有 MRMD 的女性和 61 名非 MRMD 对照者进行了异丙肾上腺素敏感性测试，以评估β-肾上腺素能受体（β-AR）反应性。然后，一部分（43 名 MRMD 和 50 名非 MRMD）进入双盲、安慰剂对照、交叉试验，以检查静脉注射普萘洛尔对β-AR 阻断对实验（冷加压和缺血）和临床（麦吉尔疼痛问卷评分）疼痛敏感性的影响。患有 MRMD 的女性比对照组表现出更大的β1-和β2-AR 反应性、缺血性疼痛强度和情感临床疼痛评分。普萘洛尔增加了两组的冷加压疼痛耐受性，但仅在非 MRMD 女性中降低了冷痛强度和缺血性疼痛不适评分。相比之下，普萘洛尔降低了患有 MRMD 的女性的临床疼痛情感评分。探索性分析表明，只有在 MRMD 女性中，β-AR 反应性越大，对冷加压和缺血性疼痛的敏感性越高。本研究首次提供了β-AR 机制在患有 MRMD 的女性的痛觉过敏和临床疼痛中的作用的证据。
本文描述了β-肾上腺素能受体刺激和阻断对患有 MRMD 的女性的实验和临床疼痛敏感性的影响。本研究的结果可能对管理患有 MRMD 的女性经前期大量躯体症状具有重要意义。
