Clinical profile of comorbid dysmenorrhea and bladder sensitivity: a cross-sectional analysis

Tu, Frank F.; Datta, Avisek; Atashroo, Diana; Senapati, S.; Roth, Genevieve E.; Clauw, Daniel J.; Hellman, Kevin M.

doi:10.1016/j.ajog.2019.12.010

Cited by 20 publications

(18 citation statements)

References 28 publications

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“…At an initial screening session, participants completed questionnaire measures encompassing medical, surgical, psychological, and gynecological history. A full list of all questionnaires administered in the larger clinical trial are reported elsewhere (Tu et al, 2020); however, those pertinent in the present investigation are described here and reported in Table 1. In particular, a subset of questions from the Brief Symptom Inventory (BSI; Derogatis & Melisaratos, 1983) representing the somatic symptom subscale evaluated the psychological distress related to the perception of bodily discomfort. Participants rated on a 5-point scale of distress a series of questions that assessed perceptions of bodily pain, such as "Faintness or dizziness", "Pains in heart or chest", "Numbness or tingling in parts of your body", etc.…”

Section: Methodsmentioning

confidence: 99%

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

Kmiecik

Silton

et al. 2020

Preprint

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Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.

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Section: Methodsmentioning

confidence: 99%

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

Kmiecik

Silton

et al. 2020

Preprint

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“…30 To compare the bladder test results with adult findings, we conducted a pilot analysis comparing this data set with our prior published data. 59 Because our prior cohort recruited a highly enriched sample of adult participants with both dysmenorrhea and bladder sensitivity, the full raw data set would not be an appropriate comparison. Therefore, for this comparison, we analyzed a subset of the full adult data set that would correspond to the approximate incidence in the community of both pain free controls (50%), moderate/severe dysmenorrhea (;40%), and moderate/severe dysmenorrhea with bladder sensitivity (;10%).…”

Section: Data Analysesmentioning

confidence: 99%

“…Bladder sensitivity was assessed; using a noninvasive filling task, we previously validated in adult females to identify subclinical intermediate phenotypes for BPS. 22,59,60,63 Before the study visit, parents were instructed to make sure adolescents were well hydrated, and there were no restrictions on how much adolescents could drink before testing. To avoid diuresis, adolescents were instructed to avoid caffeine 6 hours before the testing.…”

Section: Experimental Bladder Pain Testmentioning

confidence: 99%

Noninvasive bladder testing of adolescent females to assess visceral hypersensitivity

Hellman

Roth

et al. 2021

Pain

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Excess pain after visceral provocation has been suggested as a marker for chronic pelvic pain risk in women. However, few noninvasive tests have been validated that could be performed readily on youth in early risk windows. Therefore, we evaluated the validity and reliability of a noninvasive bladder pain test in 124 healthy premenarchal females (median age 11, [interquartile range 11-12]), as previously studied in adult women. We explored whether psychosocial, sensory factors, and quantitative sensory test results were associated with provoked bladder pain and assessed the relation of bladder pain with abdominal pain history. Compared with findings in young adult females (age 21 [20-28]), results were similar except that adolescents had more pain at first sensation to void (P 5 0.005) and lower maximum tolerance volume (P , 0.001). Anxiety, depression, somatic symptoms, and pain catastrophizing predicted provoked bladder pain (P's , 0.05). Bladder pain inversely correlated with pressure pain thresholds (r 5 20.25, P , 0.05), but not with cold pressor pain or conditioned pain modulation effectiveness. Bladder pain was also associated with frequency of abdominal pain symptoms (r 5 0.25, P 5 0.039). We found strong retest reliability for bladder pain at standard levels of sensory urgency in 21 adolescents who attended repeat visits at 6 to 12 months (intraclass correlations 5 0.88-0.90). Noninvasive bladder pain testing seems reproducible in adolescent females and may predict abdominal pain symptomatology. Confirmation of our findings and further investigation of the bladder test across menarche will help establish how visceral sensitivity contributes to the early trajectory of pelvic pain risk.

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“…27,28 This group's experimental profile and presence of mild clinical symptoms (occasional mild symptoms below the threshold for diagnosis of chronic pain conditions) suggest an increased risk of developing chronic pelvic pain. 27,28 In this study, we compare serum sex steroid levels and sex hormone-binding globulin (SHBG) from women with DYSB to healthy pain-free controls (HC), women with dysmenorrhea (DYS ¼ dysmenorrhea without bladder sensitivity, or other chronic pain conditions), and those formally diagnosed with bladder pain syndrome (BPS). We also examined the relationship of sex steroids with psychological profiles and experimental pain sensitivity to understand whether their role on pain experience is related to these common potentially contributing factors.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Circulating sex steroids and bladder pain sensitivity in dysmenorrhea

et al. 2021

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Although elevated estradiol levels facilitate chronic pelvic pain in animal models, it remains to be determined whether sex steroid levels are altered in a cross-section of women with chronic pelvic pain (CPP) and those at-risk for developing CPP. We sought to determine if sex steroid levels are increased in women with menstrual pain and whether those changes were more extreme in two groups of women with worsened pelvic pain profiles: a) dysmenorrhea plus evidence of bladder pain sensitivity and b) bladder pain syndrome. Serum samples were collected during the mid-luteal phase to measure estradiol, progesterone, testosterone, and sex hormone-binding globulin. We also compared quantitative sensory testing profiles to evaluate how sex steroid differences influence proposed pain sensitivity mechanisms. Women with combined dysmenorrhea and bladder sensitivity had higher estradiol concentrations than controls (487 [IQR 390 – 641] vs 404 [336 – 467] pmol/L, p = 0.042). Bladder pain syndrome participants had greater sex hormone-binding globulin than controls (83 [71 – 108] vs 55 [42 – 76 nmol/L; p = 0.027). Levels of pain sensitivity and mood were different across the groups, but the only significant relationship to sex steroids was that sex hormone-binding globulin was correlated to somatic symptoms ( r = 0.26, p = 0.03). These findings show women potentially at-risk for CPP and women with diagnosed CPP exhibit altered circulating levels of sex steroids. Because these hormonal differences appear to be independent of mood or pain sensitivity, the role of sex steroids in the emergence of CPP may be via sensitization of visceral afferents.

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Clinical profile of comorbid dysmenorrhea and bladder sensitivity: a cross-sectional analysis

Cited by 20 publications

References 28 publications

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

Noninvasive bladder testing of adolescent females to assess visceral hypersensitivity

Circulating sex steroids and bladder pain sensitivity in dysmenorrhea

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