Early Menstrual Pain Impact on Multisensory Hypersensitivity

月经疼痛强度的早期轨迹和重复暴露于月经的长期影响 尽管痛经的患病率很高，但慢性盆腔疼痛（CPP）的风险尚不清楚。 观察性研究表明，月经疼痛加剧和过度的一般身体症状 意识是CPP出现的强烈风险因素。由于目前的CPP治疗效果有限， 针对已知风险因素的预防性战略仍然是一项紧迫而未得到满足的需求。月经痛，或 痛经本身对许多女性的生活质量具有深刻的负面影响，并且难以治疗。 10-20%的青少年接受治疗。在青春期发育期间，神经可塑性可以允许重复的 中度至重度月经痛的不良感觉体验，以建立多感觉 在青春期的超敏反应，增加了未来发展慢性疼痛的风险。然而， 月经疼痛的模式产生这种脆弱性需要确定，以及它们如何影响这种神经 变化因此，本研究的目的1将纵向描述痛经的轨迹模式 在月经初潮后的两年内，并确定定义这些的生理和心理因素 轨迹为了确定持续性痛经加重的危险因素，将对女孩进行两项研究， 在月经初潮后的几年随访中，使用前瞻性月经症状日记沿着仔细分类 生理、心理和发育因素的影响。目标2将测试最坏的，持久的， 痛经的轨迹有最高的随后的风险多感觉过敏两年后，作为一个 可能是全面爆发的CPP的前兆。此外，这一目标将评估多感觉神经功能障碍风险的变化， 反复经痛后的超敏反应由特定的脊柱或中枢机制介导。 多感觉超敏反应将通过复合潜在变量进行测量，包括自我报告的 症状清单和实验诱发反应的标准电池的不同感觉 挑衅测试具体的机制进行测试，作为调解人，包括前额叶和初级感觉 皮层活动、脑干下行性疼痛调制和外周压力疼痛敏感性 定量感觉测试和高密度EEG方法。创新的实验方法 测量多感觉超敏性（包括测量内脏超敏性的非侵入性方法） 灵敏度），同时进行儿童友好的大脑活动电生理测量， 联合研究小组使用的工具，广泛从事子宫和儿科疼痛 考核成功完成这个项目，针对慢性盆腔疼痛的发展时间轴 脆弱性，可能会为未来的预防性干预措施确定理想的窗口，并完善评估工具， 内脏和多感官敏感性。这项研究的结果将对了解 从急性疼痛到慢性疼痛的过渡，这是一个主要的公共卫生优先事项。

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.