Early Menstrual Pain Impact on Multisensory Hypersensitivity

月经早期疼痛对多感觉超敏反应的影响

• 批准号: 10436327
• 负责人: Frank Fu-sheng Tu
• 金额: $ 64.77万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-22 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10436327
• 关键词: Accounting; Address; Adolescence; Adolescent; Adult; Affect; Anxiety; Auditory; Awareness; Biological Assay; Bladder; Brain; Brain Stem; Cataloging; Child; Childhood; Complement component C6; Development; Dysmenorrhea; Electroencephalography; Electrophysiology (science); Equipment and supply inventories; Exhibits; Exposure to; Friends; Functional disorder; Future; High Prevalence; Hypersensitivity; Learning; Link; Longitudinal Studies; Measurement; Measures; Mediating; Mediator; Menarche; Menstruation; Mental Depression; Methods; Michigan; Mission; National Institute of Child Health and Human Development; Neurologic; Neuronal Plasticity; Observational Study; Pain; Pain Measurement; Pain Threshold; Pain intensity; Pain management; Participant; Pathway interactions; Patient Self-Report; Pattern; Pelvic Pain; Peripheral; Persons; Physiological; Predisposition; Prevention; Prevention strategy; Prospective Studies; Psychological Factors; Psychophysics; Psychosocial Factor; Puberty; Quality of life; Questionnaires; Recording of previous events; Refractory; Reproductive Biology; Reproductive Process; Research; Research Priority; Risk; Risk Factors; Self Assessment; Sensory; Spinal; Stimulus; Stress; Symptoms; Tactile; Testing; Time; Uterine Diseases; Uterus; Vertebral column; Visceral; Visceral pain; Visual; Woman; Work; body map; boys; chronic pain; chronic painful condition; chronic pelvic pain; cohort; conditioned pain modulation; coping; density; design; diaries; experience; follow-up; girls; improved; indexing; innovation; multisensory; neural; neuromechanism; pain chronification; pain sensitivity; peer; pressure; preventive intervention; prospective; psychologic; psychosocial; public health priorities; recruit; reproductive; response; sensory cortex; success; timeline; tool

The early trajectory of menstrual pain intensity and the long-term impact of repeated exposure to menstrual pain on chronic pelvic pain (CPP) risk is unknown, despite the high prevalence of dysmenorrhea. Observational studies implicate both heightened menstrual pain and excess general bodily symptom awareness as strong risk factors for CPP emergence. Since current treatments for CPP have limited success, preventative strategies, targeting known risk factors, remain an urgent, unmet need. Menstrual pain, or dysmenorrhea, itself has a profound negative impact on quality of life for many women, and is refractory to treatment in 10-20% of adolescents. During pubertal development, neuroplasticity could permit repeated adverse sensory experiences from moderate-to-severe menstrual pain to establish multisensory hypersensitivity during adolescence, increasing the future risk for development of chronic pain. However, which patterns of menstrual pain create this vulnerability need to be determined, and how they effect such neural changes. Therefore, Aim 1 of this study will characterize the trajectory patterns of dysmenorrhea longitudinally over the two years post-menarche and determine the physiological and psychological factors defining these trajectories. To determine risk factors for persistent heightened dysmenorrhea, girls will be studied for two years of follow-up after menarche, using prospective menstrual symptom diaries along with careful cataloging of menstrual, psychosocial and developmental factors. Aim 2 will then test whether the worst, persistent dysmenorrhea trajectory has the highest subsequent risk for multisensory hypersensitivity two years later, as a likely precursor to full blown CPP. Additionally, this aim will assess if change in risk of multisensory hypersensitivity following repeated menstrual pain is mediated by specific spinal or central mechanisms. Multisensory hypersensitivity will be measured by composite latent variable encompassing both self-reported symptom inventories and experimentally evoked responses to a standard battery of different sensory provocation tests. Specific mechanisms to be tested as mediators include prefrontal and primary sensory cortex activity, brainstem descending modulation of pain and peripheral pressure pain sensitivity using quantitative sensory testing and high-density EEG methods. The innovative experimental methods for measuring multisensory hypersensitivity (including non-invasive methods for measuring visceral sensitivity), with simultaneous kid-friendly electrophysiological measurements of brain activity, build on tools used by the combined research team, that is extensively engaged in uterine and pediatric pain assessment. Successful completion of this project, targeting the developmental timeline of chronic pelvic pain vulnerability, likely will define ideal windows for future preventative interventions and refine tools for evaluating visceral and multisensory sensitivity. Findings in this study will be uniquely valuable for understanding the transition from acute to chronic pain, a major public health priority.

经痛强度的早期轨迹以及反复接触经痛的长期影响 尽管痛经的患病率很高，但疼痛对慢性盆腔疼痛（CPP）的风险尚不清楚。 观察性研究表明经痛加剧和全身症状过度 意识是 CPP 出现的强大风险因素。由于目前 CPP 的治疗效果有限， 针对已知风险因素的预防战略仍然是一项紧迫且未得到满足的需求。月经疼痛，或 痛经本身对许多女性的生活质量产生深远的负面影响，并且难以治愈 10-20%的青少年接受治疗。在青春期发育期间，神经可塑性可能允许重复 中度至重度经痛的不良感觉体验，以建立多感觉 青春期过敏，增加未来发生慢性疼痛的风险。然而，哪 需要确定造成这种脆弱性的月经疼痛模式，以及它们如何影响这种神经 变化。因此，本研究的目标1将纵向描述痛经的轨迹模式 初潮后两年，确定定义这些的生理和心理因素 轨迹。为了确定持续加剧痛经的危险因素，将对女孩进行两项研究 初潮后多年的随访，使用前瞻性月经症状日记并仔细分类 月经、心理社会和发育因素。然后目标 2 将测试最坏的情况是否持续存在 痛经轨迹在两年后出现多感觉超敏反应的风险最高， 可能是全面发展的 CPP 的前身。此外，该目标将评估多感官风险是否发生变化 反复经痛后的过敏是由特定的脊柱或中枢机制介导的。 多感觉超敏反应将通过包含自我报告的复合潜在变量来测量 症状清单和对不同感官标准电池的实验诱发反应 挑衅测试。作为调解者进行测试的具体机制包括前额叶和初级感觉 皮层活动、脑干下行疼痛调节和外周压力疼痛敏感性 定量感觉测试和高密度脑电图方法。创新的实验方法 测量多感觉超敏反应（包括测量内脏超敏反应的非侵入性方法） 灵敏度），同时对儿童友好的大脑活动进行电生理测量，构建 联合研究团队使用的工具，该团队广泛从事子宫和儿科疼痛研究 评估。成功完成该项目，针对慢性盆腔疼痛的发展时间表 脆弱性，可能会为未来的预防性干预措施定义理想的窗口，并完善评估工具 内脏和多感官敏感性。这项研究的结果对于理解 从急性疼痛向慢性疼痛的转变是一项重要的公共卫生优先事项。