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      Experimental and procedural pain responses in primary dysmenorrhea: a systematic review

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          Abstract

          Primary dysmenorrhea (PD) has been the focus of a number of experimental pain studies. Although a number of reviews exist, few have critically evaluated the existing body of research on PD and experimental and procedural pain. Data from 19 published research articles that include women with PD and responses to an experimental or procedural pain stimulus (or stimuli) suggest that women with PD may have elevated pain reactivity, as compared to women without PD. This pattern appears to be true across different phases of the menstrual cycle. However, there is an abundance of conflicting findings, which may be due to significant methodological issues such as inconsistent definitions of PD, wide variation in experimental pain methodologies, and inaccurate assessment of the menstrual cycle. Future research should focus on identifying specific symptoms (i.e., pain threshold ratings) to more clearly define what constitutes PD, establish reliable and valid laboratory testing protocols, and assess the menstrual cycle with greater precision.

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          Most cited references 54

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          Central pain mechanisms in chronic pain states--maybe it is all in their head.

          Mechanisms underlying chronic pain differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialities have historically applied wide-ranging labels (e.g., fibromyalgia (FM), irritable bowel syndrome, interstitial cystitis and somatisation) for what now is emerging as a single common set of CNS processes. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties and a higher rate of co-morbid mood disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment.

            To explore the prevalence of dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students' management strategies, and their knowledge of available treatment. A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The following definition of dysmenorrhoea was used: any type of pain or discomfort associated with menstrual periods including cramps, nausea, and headaches. The reported prevalence of dysmenorrhea among these girls was 80%; 53% of those girls with dysmenorrhea reported that it limited their activities. In particular, 37% said that dysmenorrhea affected their school activities. The most common medication used by those reporting dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for dysmenorrhea. The prevalence and impact of dysmenorrhea on Grade 11 and 12 girls is high, and they lack knowledge of and experience with effective treatment. Health education measures are needed in this area to prevent unnecessary suffering and interruption to school routine.
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              Dysmenorrhoea is associated with central changes in otherwise healthy women.

              Patients with chronic pain conditions demonstrate altered central processing of experimental noxious stimuli, dysfunction of the hypothalamic-pituitary-adrenal axis, and reduced quality of life. Dysmenorrhoea is not considered a chronic pain condition, but is associated with enhanced behavioural responses to experimental noxious stimuli. We used behavioural measures, functional magnetic resonance imaging, and serum steroid hormone levels to investigate the response to experimental thermal stimuli in otherwise healthy women, with and without dysmenorrhoea. Women with dysmenorrhoea reported increased pain to noxious stimulation of the arm and abdomen throughout the menstrual cycle; no menstrual cycle effect was observed in either group. During menstruation, deactivation of brain regions in response to noxious stimulation was observed in control women but not in women with dysmenorrhoea. Without background pain (ie, in nonmenstrual phases), activity in the entorhinal cortex appeared to mediate the increased responses in women with dysmenorrhoea. Mean cortisol was significantly lower in women with dysmenorrhoea and was negatively correlated with the duration of the symptom. Additionally, women with dysmenorrhoea reported significantly lower physical but not mental quality of life. Thus, many features of chronic pain conditions are also seen in women with dysmenorrhoea: specifically a reduction in quality of life, suppression of the hypothalamic-pituitary-adrenal axis, and alterations in the central processing of experimental noxious stimuli. These alterations persist when there is no background pain and occur in response to stimuli at a site distant from that of the clinical pain. These findings indicate the potential importance of early and adequate treatment of dysmenorrhoea. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                12 September 2017
                : 10
                : 2233-2246
                Affiliations
                [1 ]Pediatric Pain and Palliative Care Program
                [2 ]Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
                Author notes
                Correspondence: Laura A Payne, Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 22-464 MDCC, Los Angeles, CA 90095-1752, USA, Tel +1 310 825 6953, Email LPayne@ 123456mednet.ucla.edu
                Article
                jpr-10-2233
                10.2147/JPR.S143512
                5604431
                © 2017 Payne et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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