Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Radiology Department, Chong Qing General Hospital, Chong Qing, China.
Eur J Pain. 2019 May;23(5):994-1005. doi: 10.1002/ejp.1368. Epub 2019 Feb 19.
Primary dysmenorrhoea (PDM), characterized as menstrual pain without pelvic pathology, is associated with pain-related negative mood and hormone fluctuations. Previous studies strongly supported the link between pain and negative mood in affected individuals; however, it remains largely unknown in patients with PDM.
We focused on the effects how spontaneous pain, negative mood and hormone levels played on the central nervous system in 34 PDM women and 33 matched healthy controls across their cycles (periovulatory phase and menstruation phase) by using T1-weighted and functional imaging. Voxel-based morphometry and functional connectivity (FC) analyses were performed to evaluate brain structural and functional changes. Hormone concentrations (oestradiol, progesterone and cortisol) were also obtained.
Abnormal state-related GM volume in the amygdala was found between periovulatory and menstruation phases in PDM. Furthermore, larger amygdalar volume was observed in patients' menstruation phase, which was significantly correlated with higher levels of cortisol. In addition, we found increased amygdala-seeded FC in vlPFC, which may be associated with pain intensity and negative mood in PDM women during the pain state.
Taken together, we found women with PDM had structural and functional abnormalities in the amygdala, which associated with stress hormone levels, pain intensity and negative mood, may reflect disturbed emotional and pain modulation in women with PDM.
Our findings provide further evidence of amygdala-related abnormalities, which may be associated with pain-related affective distress and hormonal fluctuations in women with PDM, and complement the brain mechanism investigations for the pathophysiology of PDM.
原发性痛经（PDM）是指无盆腔病变的月经疼痛，与疼痛相关的负面情绪和激素波动有关。先前的研究强烈支持疼痛与受影响个体负面情绪之间的联系；然而，在 PDM 患者中，这在很大程度上仍然未知。
我们通过使用 T1 加权和功能成像，在 34 名 PDM 女性和 33 名匹配的健康对照者的周期（排卵前阶段和月经期）中，重点研究了自发疼痛、负面情绪和激素水平对中枢神经系统的影响。进行了基于体素的形态测量和功能连接（FC）分析，以评估大脑结构和功能变化。还获得了激素浓度（雌二醇、孕酮和皮质醇）。
在 PDM 中，在排卵前阶段和月经期之间发现杏仁核的与异常状态相关的 GM 体积异常。此外，在患者的月经期观察到更大的杏仁核体积，其与皮质醇水平的升高显著相关。此外，我们发现杏仁核种子的 vlPFC 中的 FC 增加，这可能与 PDM 女性在疼痛状态下的疼痛强度和负面情绪有关。
综上所述，我们发现 PDM 女性的杏仁核存在结构和功能异常，与应激激素水平、疼痛强度和负面情绪有关，可能反映了 PDM 女性情感和疼痛调节的紊乱。
我们的发现提供了进一步的证据，表明杏仁核相关异常可能与 PDM 女性的疼痛相关的情感困扰和激素波动有关，并补充了 PDM 病理生理学的大脑机制研究。
