Early Menstrual Pain Impact on Multisensory Hypersensitivity

月经疼痛强度的早期轨迹和反复经期暴露的长期影响 尽管痛经的发病率很高，但慢性盆腔疼痛(CPP)的风险尚不清楚。 观察性研究表明，月经疼痛加剧和全身症状加重有关 意识是CPP出现的强烈危险因素。由于目前对CPP的治疗效果有限， 针对已知风险因素的预防性战略仍然是一项迫切的、尚未得到满足的需求。月经痛，或 痛经本身对许多女性的生活质量有深远的负面影响，而且对 10%-20%的青少年接受治疗。在青春期发育期间，神经可塑性可以重复 从中到重度月经疼痛到建立多感觉的不良感觉体验 青春期的过敏症，增加了未来发展为慢性疼痛的风险。然而，这一点 月经疼痛的模式造成这种脆弱性需要确定，以及它们如何影响这种神经。 改变。因此，本研究的目标1将纵向描述痛经的轨迹模式。 在月经初潮后的两年里，并确定决定这些的生理和心理因素 轨迹。为了确定持续性高痛经的危险因素，将对女孩进行两项研究 月经初潮后的多年随访，使用预期的月经症状日记并仔细编目 月经、心理社会和发育因素。然后，目标2将测试最坏的、持久的 痛经轨迹在两年后发生多感官过敏的风险最高，因为 很可能是CPP的前身。此外，这一目标将评估多感官风险的变化 反复月经疼痛后的过敏反应是由特定的脊椎或中枢机制介导的。 多感官敏感度将通过包含两个自我报告的复合潜变量来衡量 症状清单和对不同感官的标准电池的实验诱发反应 挑衅测试。作为中介的具体机制包括前额叶和初级感觉 皮层活动、脑干对疼痛的下行调制和外周压痛敏感性 定量感觉测试和高密度脑电方法。创新的实验方法 测量多感官超敏反应(包括非侵入性测量内脏 敏感度)，通过同时进行适合儿童的脑活动电生理测量，构建 关于广泛从事子宫和儿科疼痛的联合研究团队使用的工具 评估。成功完成这一项目，目标是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定义理想的窗口，并改进评估工具 本能和多感官敏感度。这项研究的发现将对理解 从急性疼痛过渡到慢性疼痛，这是一项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.