cDr. Laura

Menstrual pain, also known as dysmenorrhea, affects up to 90 percent of women and adolescent girls. For some women and girls, the cramping can be so severe that they miss work or school. Yet little research has focused on the condition; since 1944, fewer than two dozen laboratory-based pain studies focusing on menstrual pain without an identified medical cause have been published.

But things are beginning to change, thanks to researchers like UCLA's Dr. Laura Payne. Over-the-counter pain relievers and birth control pills are commonly used to alleviate menstrual pain, but not everyone is helped. A better understanding of menstrual pain may lead to additional treatments, she said.

What's more, there is a growing recognition that severe menstrual pain may presage other health conditions. "It may be an early indicator of some dysfunction in the pain control system that, over time, would lead to women developing chronic pelvic pain," Dr. Payne said. "It's important to identify those who are at risk for future pain problems."

Dr. Payne has examined the relationship between menstrual pain and anxiety in adolescent girls. In a CTSI-supported study published this year in Pain Medicine, Dr. Payne compared measures of anxiety and pain in two groups: girls with chronic pain caused by migraines, irritable bowel syndrome and other conditions, and girls without chronic pain. A total of 84 girls ages 10-17 participated in the study.

The girls were asked to rate the severity of their menstrual pain, whether they took medication for their pain, and how the pain affected their daily lives. In addition, the girls participated in a laboratory test designed to measure pain tolerance. They dipped a hand into very cold water and keep it there for as long as possible, up to three minutes.

Girls also filled out questionnaires that measured two forms of anxiety: anxiety sensitivity, which is the fear of physical sensations of anxiety, such as a pounding heart; and pain catastrophizing, which is the tendency to think very negatively about pain.

Dr. Payne hypothesized that menstrual pain would be linked to laboratory pain tolerance, pain catastrophizing, and anxiety sensitivity in girls with chronic pain.  Her hypothesis was based in part on studies by others in adult women, which found associations between menstrual pain and anxiety disorders, depression, and other psychological conditions.

Girls in the chronic pain group reported more severe menstrual pain and were more likely to take birth control pills in addition to aspirin and other pain relievers for cramps. However, there was no difference between groups in the length of time they could keep their hands in the cold water. 

On the psychological measures, girls with chronic pain were significantly more likely to catastrophize about pain. But there was no difference in anxiety sensitivity between the two groups.  

 For girls with chronic pain, menstrual pain was correlated with anxiety sensitivity and pain catastrophizing.  However, for girls without chronic pain, menstrual pain was correlated with laboratory pain. According to Dr. Payne, the results suggest that girls with severe menstrual pain, but no other chronic pain conditions, may have a higher sensitivity to pain in general.

The results suggest the mechanism behind menstrual pain is different in the two groups.

Dr. Payne said psychological factors may have a role in how girls with chronic pain experience menstrual pain. For girls in this group, menstrual pain was related to anxiety about the physical sensations of anxiety and anxiety about pain, or pain catastrophizing. 

The findings have positive implications in terms of treatment. As the study reveals a close relationship between mind and body, Dr. Payne is conducting another study investigating a mind-body intervention, including components of cognitive behavioral therapy, as a treatment for moderate to severe menstrual pain. She believes decatastrophizing techniques such as mindfulness and coping would be an effective treatment for menstrual pain in general, not just girls with a chronic pain condition. Dr. Payne's proposed treatment would be a welcome alternative to the only two options currently available to women: birth control, or OTC pain relievers like ibuprofen.

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Kimberly Wang is a fourth-year, pre-med student from Fair Lawn, N.J. She is majoring in English.

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