Thomann Verena, Gomaa Nadya, Stang Marina, Funke Susanne A, Meissner Karin
Institute for Applied Health Sciences, Faculty of Applied Natural Sciences and Health, Coburg University of Applied Sciences and Arts, Coburg, Germany.
Institute for Bioanalysis, Faculty of Applied Natural Sciences and Health, Coburg University of Applied Sciences and Arts, Coburg, Germany.
BMC Womens Health. 2025 May 21;25(1):241. doi: 10.1186/s12905-025-03784-2.
Primary dysmenorrhea, characterized by painful menstruation, significantly impacts the quality of life for women worldwide. Negative expectations and associated emotions are known to trigger nocebo effects and may also influence cyclic menstrual pain. In this study, we investigated the role of pain expectations and negative anticipatory emotions as potential contributing factors to hyperalgesia in women with severe menstrual pain, compared to women with absent or mild menstrual pain.
We conducted a prospective case-control study in women with severe menstrual pain due to primary dysmenorrhea, comparing them with age-matched women with absent or mild menstrual pain. Data collection included the Depression, Anxiety, and Stress Scale (DASS-21) at baseline, as well as daily numeric rating scales (NRS) to evaluate pain expectations, anticipatory negative emotions, and daily stress during the 10 days preceding menstruation. Saliva samples were collected to evaluate the Cortisol Awakening Response (CAR) before menstruation, and pain was assessed during the first 3 days of menstruation.
Women with high menstrual pain reported significantly higher DASS-21 anxiety levels compared to low-pain controls, although still within the normal range (median [IQR], 3 [2; 5] vs. 1 [1; 3], p <.05). In the 10 days preceding menstruation, the high-pain group expected significantly higher maximum pain levels than controls (median [IQR], 8 [7.3; 8.5] vs. 2.1 [1; 3.3], p <.001), which aligned with their actual experiences of maximum pain during menstruation (6.5 [4.8; 7.7] vs. 1.2 [0.7; 2.3], p <.001). Anticipatory stress (2.1 [0.9; 4.2] vs. 0.2 [0; 0.9], p <.001), anticipatory anxiety (0.7 [0.0; 2.3] vs. 0 [0; 0], p <.001), anticipatory worry (1.3 [0.4; 2.6] vs. 0.1 [0; 0.3], p <.001), and anticipatory anger (0.7 [0; 1.5] vs. 0 [0; 0.2], p <.01) were also significantly higher in the high-pain group in the 10 days before menstruation. The CAR showed no significant differences between groups in the days before menstruation. Correlational analyses revealed multiple positive associations between expected pain levels, anticipatory negative emotions, and subsequently perceived levels of menstrual pain in both groups (all p-values < 0.05).
This pioneering study supports the hypothesis that cognitive-emotional factors such as heightened pain anticipation and negative emotions intensify menstrual pain severity in primary dysmenorrhea, although causal conclusions cannot be drawn from this observational study. Strategies aimed at optimizing expectations could play a significant role in managing primary dysmenorrhea.
原发性痛经以经期疼痛为特征，严重影响全球女性的生活质量。已知负面期望及相关情绪会引发反安慰剂效应，还可能影响周期性的经期疼痛。在本研究中，我们调查了疼痛期望和负面预期情绪作为重度经期疼痛女性痛觉过敏潜在促成因素的作用，并与无经期疼痛或轻度经期疼痛的女性进行了比较。
我们对因原发性痛经而患有重度经期疼痛的女性进行了一项前瞻性病例对照研究，并将她们与年龄匹配的无经期疼痛或轻度经期疼痛的女性进行比较。数据收集包括基线时的抑郁、焦虑和压力量表（DASS - 21），以及在月经前10天用于评估疼痛期望、预期负面情绪和每日压力的每日数字评分量表（NRS）。采集唾液样本以评估月经前的皮质醇觉醒反应（CAR），并在月经的前3天评估疼痛情况。
与低疼痛对照组相比，经期疼痛严重的女性报告的DASS - 21焦虑水平显著更高，尽管仍在正常范围内（中位数[四分位间距]，3[2；5]对1[1；3]，p <.05）。在月经前10天，高疼痛组预期的最大疼痛水平显著高于对照组（中位数[四分位间距]，8[7.3；8.5]对2.1[1；3.3]，p <.001），这与她们在月经期间实际经历的最大疼痛情况相符（6.5[4.8；7.7]对1.2[0.7；2.3]，p <.001）。在月经前10天，高疼痛组的预期压力（2.1[0.9；4.2]对0.2[0；0.9]，p <.001）、预期焦虑（0.7[0.0；2.3]对0[0；0]，p <.001）、预期担忧（1.3[0.4；2.6]对0.1[0；0.3]，p <.001）和预期愤怒（0.7[0；1.5]对0[0；0.2]，p <.01）也显著更高。两组在月经前几天的CAR无显著差异。相关性分析显示，两组中预期疼痛水平、预期负面情绪与随后感知到的经期疼痛水平之间均存在多重正相关（所有p值<0.05）。
这项开创性研究支持了这样一种假设，即诸如疼痛预期增强和负面情绪等认知 - 情感因素会加剧原发性痛经的经期疼痛严重程度，尽管无法从这项观察性研究中得出因果结论。旨在优化期望的策略可能在原发性痛经的管理中发挥重要作用。
