Universidad San Jorge. Campus Universitario, Autov. A23 km 299, 50830. Villanueva de Gállego, Zaragoza, Spain.
Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
J Pain. 2023 Sep;24(9):1541-1554. doi: 10.1016/j.jpain.2023.04.005. Epub 2023 Apr 25.
Dysmenorrhea (DYS), or recurrent menstrual pain, is a highly prevalent pain condition among otherwise healthy women. However, the progression of DYS over time and the influence of the menstrual cycle phases need to be better understood. While the location and distribution of pain have been used to assess pain mechanisms in other conditions, they are unexplored in DYS. Thirty otherwise healthy women with severe DYS and 30 healthy control women were recruited into 3 subgroups (n = 10) according to the length of their menstrual history (<5, 5-15, or>15 years since menarche). The intensity and distribution of menstrual pain were recorded. Pressure pain thresholds at abdominal, hip, and arm sites, pressure-induced pain distribution, temporal summation of pain, and pain intensity after pressure cessation over the gluteus medius were assessed at 3 menstrual cycle phases. Compared with the healthy control women, those with DYS showed lower pressure pain thresholds in every site and menstrual cycle phase (P < .05), enlarged pressure-induced pain areas during menstruations (P < .01), and increased temporal summation and pain intensity after pressure cessation in the overall menstrual cycle (P < .05). Additionally, these manifestations were enhanced during the menstrual and premenstrual phases compared to ovulation in women with DYS (P < .01). Women with long-term DYS demonstrated enlarged pressure-induced pain distribution, enlarged menstrual pain areas, and more days with severe menstrual pain compared to the short-term DYS subgroup (P < .01). Pressure-induced and menstrual pain distributions were strongly correlated (P < .001). These findings suggest that severe DYS is a progressive condition underscored by facilitated central pain mechanisms associated with pain recurrence and exacerbation. PERSPECTIVE: Enlarged pressure-induced pain areas occur in DYS, associated with the length of the condition and the distribution of menstrual pain. Generalized hyperalgesia is present throughout the entire menstrual cycle and intensifies during premenstrual and menstrual phases.
痛经（DYS），即反复性月经疼痛，是一种在健康女性中发病率极高的疼痛病症。然而，DYS 的发展进程以及月经周期各阶段的影响仍需深入了解。尽管疼痛的位置和分布已被用于评估其他病症的疼痛机制，但在 DYS 中尚未得到探索。根据初潮后月经史的长短（<5 年、5-15 年或>15 年），将 30 名患有严重 DYS 的健康女性和 30 名健康对照女性纳入 3 个亚组（每组 10 名）。记录月经痛的强度和分布。在 3 个月经周期阶段评估腹部、臀部和手臂部位的压痛阈值、压痛诱发疼痛的分布、疼痛的时间总和以及压后臀中肌的疼痛强度。与健康对照组女性相比，DYS 组女性在每个部位和每个月经周期阶段的压痛阈值均较低（P <.05），月经期压痛诱发疼痛区域增大（P <.01），整个月经周期的疼痛时间总和和压后疼痛强度增加（P <.05）。此外，与排卵相比，DYS 女性在月经和经前期阶段的这些表现更为明显（P <.01）。长期 DYS 女性的压痛诱发疼痛分布、月经痛区域以及严重月经痛天数均大于短期 DYS 亚组（P <.01）。压痛诱发疼痛分布与月经痛分布呈强相关性（P <.001）。这些发现表明，严重 DYS 是一种进展性疾病，其特点是与疼痛复发和加重相关的中枢疼痛机制易化。观点：DYS 中出现压痛诱发疼痛面积增大，与疾病的长短以及月经痛的分布有关。整个月经周期都存在广泛的痛觉过敏，并且在经前期和月经期加重。
