Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
J Pain. 2021 Sep;22(9):1084-1096. doi: 10.1016/j.jpain.2021.03.139. Epub 2021 Mar 21.
Despite emerging evidence of associations between dysmenorrhea, enhanced pain sensitivity, and functional neuroimaging patterns consistent with chronic pain, it is unknown whether dysmenorrhea is prospectively associated with chronic pain development. Gaining a better understanding of this relationship could inform efforts in prevention of chronic pain. Using data from the national Midlife in the United States cohort, we examined the prospective association between dysmenorrhea and chronic pain development during a 10-year follow-up (starting 10 years after dysmenorrhea was measured) among 874 community-dwelling women aged 25-74 at baseline (when dysmenorrhea was measured). We fit modified Poisson regression models adjusting for sociodemographic, lifestyle and psychosocial factors. Among women who were menstruating at baseline, self-reported dysmenorrhea was associated with a 41% greater (95% confidence interval [CI] = 6%-88%) risk of developing chronic pain. Women with dysmenorrhea also developed chronic pain in more body regions (≥3 regions vs 1-2 regions vs none, odds ratio [OR] = 1.77, 95% CI = 1.18-2.64) and experienced greater pain interference (high-interference vs low-interference vs none, OR = 1.73, 95% CI = 1.15-2.59). Among women who had stopped menstruation at baseline, we did not find evidence of an association between their history of dysmenorrhea and subsequent risk of chronic pain development. Results suggest dysmenorrhea may be a general risk factor for chronic pain development among menstruating women. PERSPECTIVE: This study supports the temporality of dysmenorrhea and chronic pain development in a national female sample. Dysmenorrhea was also associated with developing more widespread and disabling pain among women who were still menstruating. Early management of dysmenorrhea may reduce the development and severity of chronic pain in women, although further research is required to determine whether dysmenorrhea is a causal risk factor or a risk marker of chronic pain.
尽管有越来越多的证据表明痛经、疼痛敏感性增强以及与慢性疼痛一致的功能性神经影像学模式之间存在关联，但尚不清楚痛经是否与慢性疼痛的发展具有前瞻性关联。更好地了解这种关系可以为预防慢性疼痛的努力提供信息。使用来自美国中年人群的全国性队列研究的数据，我们在 10 年的随访中（从痛经测量后 10 年开始），检查了 874 名年龄在 25-74 岁之间、基线时有生育能力（痛经测量时）的社区居住女性中痛经与慢性疼痛发展之间的前瞻性关联。我们拟合了修正后的泊松回归模型，调整了社会人口统计学、生活方式和心理社会因素。在基线时有月经的女性中，自我报告的痛经与发展为慢性疼痛的风险增加 41%（95%置信区间[CI] = 6%-88%）相关。有痛经的女性还会出现更多身体区域的慢性疼痛（≥3 个区域与 1-2 个区域与无区域，比值比[OR] = 1.77，95%CI = 1.18-2.64），并且经历更大的疼痛干扰（高干扰与低干扰与无干扰，OR = 1.73，95%CI = 1.15-2.59）。在基线时已经绝经的女性中，我们没有发现她们痛经史与随后慢性疼痛发展风险之间存在关联的证据。结果表明，痛经可能是生育期女性慢性疼痛发展的一般危险因素。观点：这项研究支持在全国女性样本中痛经和慢性疼痛发展之间的时间关系。痛经还与仍在月经期间的女性更广泛和更具致残性疼痛的发展有关。痛经的早期管理可能会降低女性慢性疼痛的发展和严重程度，但需要进一步研究以确定痛经是否是慢性疼痛的因果危险因素还是慢性疼痛的风险标志物。
