Abdominal skeletal muscle activity precedes spontaneous menstrual cramping pain in primary dysmenorrhea.
Abdominal skeletal muscle activity precedes spontaneous menstrual cramping pain in primary dysmenorrhea.
复制标题
原发性痛经患者腹部骨骼肌活动先于自发性月经痉挛性疼痛。
DOI：
10.1016/j.ajog.2018.04.050
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发表时间：
2018-07
影响因子：
9.8
通讯作者：
Hellman KM
中科院分区：
文献类型：
--
作者：
Oladosu FA;Tu FF;Farhan S;Garrison EF;Steiner ND;Roth GE;Hellman KM
痛经是一种普遍的疼痛状况，影响20-50%的育龄妇女。内脏器官（如子宫）的扩张可引起内脏运动反射，导致不自主骨骼肌活动和牵涉性疼痛。虽然提到的腹痛机制可以促进内脏疼痛，腹肌活动的作用尚未在月经疼痛的背景下进行调查。本研究的目的是确定痛经妇女的不自主腹肌活动是否先于自发性痛经发作，以及萘普生是否会影响腹肌活动。记录严重痛经妇女（n=38）和健康对照（n=10）在月经期间的腹部肌电活动。同时，使用挤压球或视觉模拟变阻器实时测量疼痛。服用萘普生90分钟后，再次评估腹部肌电活动和月经疼痛。作为额外的对照，研究人员还记录了女性的非经期，并分析了与随机挤压灯泡有关的数据。由于尚不清楚原发性或继发性痛经/慢性盆腔疼痛的痛经机制是否不同，因此研究了病史与腹肌活动之间的关系。为了进一步研究伤害机制的差异，还测量了压力痛阈值以评估广泛疼痛敏感性的变化。在月经期间的健康对照（0.9±0.6次/小时）和月经后的痛经参与者（2.3±0.6次/小时）中，很少观察到与随机球挤压相关的腹肌活动。在月经期间痛经的参与者中，腹部肌肉活动经常与球挤压相关，表明月经痉挛疼痛（10.8±3.0次/小时；p <0.004）。而45%（17/38）的痛经女性有腹肌活动相关疼痛发作，只有13%（5/38）的患者在服用萘普生后有发作（p = 0.011）。与没有这种疼痛表型的女性相比，有腹肌活动相关疼痛的女性被诊断为继发性痛经或慢性盆腔疼痛的可能性更小（2/17）（10/21;p = 0.034）。同样，有腹肌活动相关疼痛表型的女性比没有这种表型的女性（12.4±0.3;p = 0.002）有更少的非经期疼痛天数/月（0.6±0.5）。患有腹肌活动相关疼痛的女性的压痛阈值（22.4±3.0 N）与健康对照组（22.2±3.0 N; p = 0.967）相当。相比之下，没有腹肌活动相关疼痛的女性有较低的压痛阈值（16.1±1.9 N; p = 0.039）。腹肌活动可能导致原发性痛经的痉挛痛，但可以用萘普生解决。没有痉挛相关腹肌活动的痛经患者表现出广泛的疼痛敏感性（较低的压力痛阈），并且更有可能被诊断为慢性疼痛，这表明他们的痉挛与中枢性疼痛过程的变化有关。这项初步研究提出了新的工具来表型月经疼痛，并支持多种不同的机制可能导致痛经的假设。
Dysmenorrhea is a pervasive pain condition that affects 20–50% of reproductive-aged women. Distension of a visceral organ, such as the uterus, could elicit a viscero-motor reflex resulting in involuntary skeletal muscle activity and referred pain. Although referred abdominal pain mechanisms can contribute to visceral pain, the role of abdominal muscle activity has not yet been investigated within the context of menstrual pain. The goal of this study is to determine if involuntary abdominal muscle activity precedes spontaneous episodes of menstrual cramping pain in dysmenorrheic women and if naproxen administration affects abdominal muscle activity. Abdominal electromyography activity was recorded from women with severe dysmenorrheic (n=38) and healthy controls (n=10) during menses. Simultaneously, pain was measured in real-time using a squeeze-bulb or visual analog rheostat. Ninety minutes after naproxen administration, abdominal electromyography activity and menstrual pain were re-assessed. As an additional control, women were also recorded off-menses and data were analyzed in relation to random bulb squeezes. Since it is unknown whether mechanisms of menstrual cramps are different in primary or secondary dysmenorrhea/chronic pelvic pain, the relationship between medical history and abdominal muscle activity was examined. To further examine differences in nociceptive mechanisms, pressure pain thresholds were also measured to evaluate changes in widespread pain sensitivity. Abdominal muscle activity related to random-bulb squeezing was rarely observed in healthy controls on menses (0.9 ±0.6 episodes / hour) and in dysmenorrhea participants off menses (2.3 ± 0.6 episodes / hour). In dysmenorrheic participants during menses, abdominal muscle activity was frequently associated with bulb-squeezing indicative of menstrual cramping pain (10.8 ± 3.0 episodes / hour; p <0.004). Whereas 45% (17/38) of the women with dysmenorrhea had episodes of abdominal muscle activity associated pain, only 13% (5/38) had episodes after naproxen (p = 0.011). Women with the abdominal muscle activity-associated pain were less likely to have a diagnosis for secondary dysmenorrhea or chronic pelvic pain (2/17) than women without this pain phenotype (10/21; p = 0.034). Similarly, women with the abdominal muscle activity-associated pain phenotype had less non-menstrual pain days/month (0.6 ± 0.5) than women without the phenotype (12.4 ± 0.3; p = 0.002). Women with abdominal muscle activity-associated pain had pressure pain thresholds (22.4 ± 3.0 N) comparable to healthy controls (22.2 ± 3.0 N; p = 0.967). In contrast, women without abdominal muscle activity-associated pain had lower pressure pain thresholds (16.1 ± 1.9 N; p = 0.039). Abdominal muscle activity may contribute to cramping pain in primary dysmenorrhea, but is resolvable with naproxen. Dysmenorrheic patients without cramp-associated abdominal muscle activity exhibit widespread pain sensitivity (lower pressure pain thresholds) and are more likely to also have a chronic pain diagnosis, suggesting their cramps are linked to changes in central pain processes. This preliminary study suggests new tools to phenotype menstrual pain and supports the hypothesis that multiple distinct mechanisms may contribute to dysmenorrhea.
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