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: 9768505
• 负责人: Frank Fu-sheng Tu
• 金额: $ 67.03万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768505
• 关键词: Accounting; Acute; Address; Adolescence; Adolescent; Adult; Affect; Anxiety; Auditory; Awareness; Biological Assay; Bladder; Brain; Brain Stem; Cataloging; Catalogs; Child; Childhood; Complement component C6; Development; Dysmenorrhea; Electroencephalography; Electrophysiology (science); Equipment and supply inventories; Exhibits; Exposure to; Functional disorder; Future; High Prevalence; Hypersensitivity; Learning; Link; Longitudinal Studies; Measurement; Measures; Mediating; Mediator of activation protein; 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; Preventive Intervention; 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; TimeLine; Uterine Diseases; Uterus; 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; neuromechanism; pain sensitivity; peer; pressure; prospective; psychologic; psychosocial; public health priorities; recruit; relating to nervous system; reproductive; response; sensory cortex; success; 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.

月经疼痛强度的早期轨迹和重复暴露于月经的长期影响 慢性骨盆疼痛（CPP）的疼痛尚不清楚，尽管痛经患病率很高。 观察性研究暗示了月经疼痛和过度的一般身体症状 意识是CPP出现的强大风险因素。由于目前对CPP的治疗的成功有限，因此 针对已知危险因素的预防策略仍然是紧急，未满足的需求。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，对 在10-20％的青少年中进行治疗。在青春期开发期间，神经可塑性可以允许重复 从中度到重度月经疼痛到建立多感官的不良感觉体验 青春期期间的高敏性，增加了慢性疼痛发展的未来风险。但是，哪个 月经疼痛的模式需要确定这种脆弱性，以及它们如何影响这种神经 更改。因此，本研究的目标1将在纵向上表征痛经的轨迹模式 在大学后的两年中，并确定了定义这些的生理和心理因素 轨迹。为了确定持续增强痛经的危险因素，将研究女孩的两个 初潮后的多年随访，使用前瞻性月经症状日记以及仔细的编目 月经，社会心理和发展因素。 AIM 2将测试最坏的，持续的 两年后，痛经性轨迹的多感官超敏反应的风险最高，作为一个 可能是完全吹CPP的前身。此外，此目标将评估多感官风险的变化 重复月经疼痛后的超敏反应是由特定的脊柱或中心机制介导的。 多感官超敏反应将通过复合潜在可变来衡量 症状清单和实验诱发对不同感觉的标准电池的反应 挑衅测试。要测试作为介体的特定机制包括前额叶和主要感觉 皮质活性，脑干下降调节疼痛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 测量多感官超敏反应（包括用于测量内脏的非侵入性方法 灵敏度），同时对大脑活动的儿童友好型电生理测量 关于联合研究团队使用的工具，该工具广泛从事子宫和小儿疼痛 评估。成功完成该项目，针对慢性骨盆疼痛的发展时间表 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。这项研究中的发现对于理解 从急性到慢性疼痛的过渡，这是一个主要的公共卫生优先事项。