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Heightened cold pain and pressure pain sensitivity in young female adults with moderate-to-severe menstrual pain

Slater, Helen; Paananen, Markus; Smith, Anne J.; O'Sullivan, Peter; Briggs, Andrew M.; Hickey, Martha; Mountain, Jenny; Karppinen, Jaro; Beales, Darren

doi: 10.1097/j.pain.0000000000000317
Research Paper

This study investigated the association between menstrual pain severity and psychophysical measures of cold and pressure pain sensitivity. A cross-sectional design was used with young women (n = 432) from the Western Australian Pregnancy Cohort (Raine) Study. Menstrual pain severity and oral contraception use was obtained from questionnaires at 20 and 22-year follow-ups. A visual analog scale (VAS; range from 0 [none] to 10 [unbearable]) was used to measure menstrual pain severity at both 20 and 22 years over the 3-year period, with 3 groups created: (1) no pain or mild pain (VAS 0-3), (2) at least moderate pain at a minimum of 1 of the 2 time points (hereafter named “mixed)”, and (3) severe pain (VAS 8-10). Cold pain sensitivity (dorsal wrist) and pressure pain sensitivity (lumbar spine, upper trapezius, dorsal wrist, and tibialis anterior) were assessed using standardised quantitative sensory testing protocols. Confounding variables included number of musculoskeletal pain sites, oral contraceptive use, smoking, physical activity, body mass index, psychological distress, and sleep. Severe menstrual pain and mixed menstrual pain were positively associated with heightened cold pain sensitivity (distant from menstrual pain referral site) and pressure pain sensitivity (local to menstrual pain referral site). These associations remained significant after adjusting for potential confounding variables including multisite musculoskeletal pain. Our findings suggest peripheral and central neurophysiological mechanisms contributing to heightened pain sensitivity in young women with moderate and severe menstrual pain. These data highlight the need for innovative management approaches to attenuate the negative impact of severe menstrual pain in young women.

Heightened pain sensitivity in young women with moderate-to-severe menstrual pain remains significant after adjusting for potential confounding variables, highlighting the need for innovative treatment.

aSchool of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia

bCenter for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland

cMedical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

dArthritis and Osteoporosis, Victoria, Australia

eDepartment of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Parkville, Melbourne, Australia

fSchool of Population Health, University of Western Australia, Perth, Western Australia, Australia

gFinnish Institute of Occupational Health, Health and Work Ability, Oulu, Finland

Corresponding author. Address: School of Physiotherapy and Exercise Science, Building 408, Level 3, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia. Tel.: +61 8 9266 3099; fax: +61 9266 3699. E-mail address: (H. Slater).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March 23, 2015

Received in revised form July 27, 2015

Accepted July 28, 2015

© 2015 International Association for the Study of Pain
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