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Association between dysmenorrhea and chronic pain: a systematic review and meta-analysis of population-based studies

Published:March 06, 2020DOI:https://doi.org/10.1016/j.ajog.2020.03.002

      Objective

      The objective of the study was to synthesize the epidemiological findings for the associations between dysmenorrhea, including primary dysmenorrhea and endometriosis-associated dysmenorrhea and any chronic pain conditions, including chronic pelvic pain, and chronic nonpelvic pain.

      Data Sources

      The data sources included PubMed, Embase, and CINAHL from inception to December 2019.

      Study Eligibility Criteria

      The study criteria included observational population-based studies in which the relationship between dysmenorrhea and the presence or severity of chronic pain was examined.

      Study Appraisal and Synthesis Methods

      Each study was double coded and evaluated for bias based on the modified Newcastle and Ottawa Scale. Random-effect meta-analyses were conducted to quantify the associations between dysmenorrhea and the presence of chronic pelvic and nonpelvic pain.

      Results

      Out of 9452 records, 32 studies were included, with 14 reporting associations between dysmenorrhea and chronic pelvic pain, and 20 for dysmenorrhea and chronic nonpelvic pain. Primary dysmenorrhea and endometriosis-associated dysmenorrhea were examined in 7 studies, respectively. More than 30% of the studies were categorized as poor quality, 56% as moderate, and 12.5% as high. Dysmenorrhea was positively associated with both the presence and severity of chronic pelvic and nonpelvic pain conditions. Based on 6689 women from 8 studies, those with chronic pelvic pain had 2.43 (95% confidence interval, 1.98–2.99, I2, 42%) times the odds of having dysmenorrhea compared with those without. Based on 3750 women from 11 studies, those with chronic nonpelvic pain had 2.62 (95% confidence interval, 1.84–3.72, I2, 72%) times the odds of having dysmenorrhea compared with those without. Overall, dysmenorrhea was associated with 2.50 (95% confidence interval, 2.02–3.10) times the odds of chronic pain, which did not differ by chronic pelvic vs chronic nonpelvic pain, community vs clinical populations, or different geographical regions.

      Conclusions

      Dysmenorrhea may be a general risk factor for chronic pain, although whether primary dysmenorrhea increases the risk for chronic pain is unclear. Given that adolescence is a sensitive period for neurodevelopment, elucidating the role of primary dysmenorrhea in pain chronicity in future longitudinal studies is important for preventing both chronic pelvic and nonpelvic pain.

      Key words

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      References

        • Iacovides S.
        • Avidon I.
        • Baker F.C.
        What we know about primary dysmenorrhea today: a critical review.
        Hum Reprod Update. 2015; 21: 762-778
        • Strine T.W.
        • Chapman D.P.
        • Ahluwalia I.B.
        Menstrual-related problems and psychological distress among women in the United States.
        J Womens Health (2002). 2005; 14: 316-323
        • Brinkert W.
        • Dimcevski G.
        • Arendt-Nielsen L.
        • Drewes A.M.
        • Wilder-Smith O.H.
        Dysmenorrhoea is associated with hypersensitivity in the sigmoid colon and rectum.
        Pain. 2007; 132: S46-S51
        • Hellman K.M.
        • Datta A.
        • Steiner N.D.
        • et al.
        Identification of experimental bladder sensitivity among dysmenorrhea sufferers.
        Am J Obstet Gynecol. 2018; 219: 84.e1-84.e8
        • Tu C.H.
        • Niddam D.M.
        • Chao H.T.
        • et al.
        Abnormal cerebral metabolism during menstrual pain in primary dysmenorrhea.
        Neuroimage. 2009; 47: 28-35
        • Tu C.H.
        • Niddam D.M.
        • Chao H.T.
        • et al.
        Brain morphological changes associated with cyclic menstrual pain.
        Pain. 2010; 150: 462-468
        • Liu J.
        • Liu H.
        • Mu J.
        • et al.
        Altered white matter microarchitecture in the cingulum bundle in women with primary dysmenorrhea: a tract-based analysis study.
        Hum Brain Mapp. 2017; 38: 4430-4443
        • Vincent K.
        • Warnaby C.
        • Stagg C.J.
        • Moore J.
        • Kennedy S.
        • Tracey I.
        Dysmenorrhoea is associated with central changes in otherwise healthy women.
        Pain. 2011; 152: 1966-1975
        • Wei S.Y.
        • Chao H.T.
        • Tu C.H.
        • et al.
        The BDNF Val66Met polymorphism is associated with the functional connectivity dynamics of pain modulatory systems in primary dysmenorrhea.
        Sci Rep. 2016; 6: 23639
        • Intan Low P.-C.K.
        • Liu Yu-Hsiang
        • Tsai Cheng-Lin
        • et al.
        Altered brain complexity in women with primary dysmenorrhea: a resting-state magneto-encephalography study using multiscale entropy analysis.
        Entropy. 2017; 19: 680
        • Jones A.V.
        • Hockley J.R.
        • Hyde C.
        • et al.
        Genome-wide association analysis of pain severity in dysmenorrhea identifies association at chromosome 1p13.2, near the nerve growth factor locus.
        Pain. 2016; 157: 2571-2581
        • Lee L.C.
        • Tu C.H.
        • Chen L.F.
        • et al.
        Association of brain-derived neurotrophic factor gene Val66Met polymorphism with primary dysmenorrhea.
        PLoS One. 2014; 9e112766
        • Jarrell J.
        • Arendt-Nielsen L.
        Allodynia and dysmenorrhea.
        J Obstet Gynaecol Can. 2016; 38: 270-274
        • Westling A.M.
        • Tu F.F.
        • Griffith J.W.
        • Hellman K.M.
        The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors.
        Am J Obstet Gynecol. 2013; 209: 422.e1-422.e10
        • Hoffman D.
        Central and peripheral pain generators in women with chronic pelvic pain: patient centered assessment and treatment.
        Curr Rheumatol Rev. 2015; 11: 146-166
        • Spear L.P.
        Adolescent neurodevelopment.
        J Adolesc Health. 2013; 52: S7-S13
        • Christensen J.
        • Noel M.
        • Mychasiuk R.
        Neurobiological mechanisms underlying the sleep-pain relationship in adolescence: a review.
        Neurosci Biobehav Rev. 2019; 96: 401-413
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • et al.
        The REDCap consortium: building an international community of software partners.
        J Biomed Inform. 2019; 95: 103208
        • Deeks J.J.
        • Dinnes J.
        • D'Amico R.
        • et al.
        Evaluating non-randomised intervention studies.
        Health Technol Assess (Winchester, England). 2003; 7 (iii-x, 1-173)
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ (Clin Res Ed). 2003; 327: 557-560
        • Gurel H.
        • Atar Gurel S.
        Dyspareunia, back pain and chronic pelvic pain: the importance of this pain complex in gynecological practice and its relation with grandmultiparity and pelvic relaxation.
        Gynecol Obstet Invest. 1999; 48: 119-122
        • Porpora M.G.
        • Koninckx P.R.
        • Piazze J.
        • Natili M.
        • Colagrande S.
        • Cosmi E.V.
        Correlation between endometriosis and pelvic pain.
        J Am Assoc Gynecol Laparoscop. 1999; 6: 429-434
        • Silva G.P.
        • Nascimento A.L.
        • Michelazzo D.
        • et al.
        High prevalence of chronic pelvic pain in women in Ribeirao Preto, Brazil, and direct association with abdominal surgery.
        Clinics (Sao Paulo). 2011; 66: 1307-1312
        • Zondervan K.T.
        • Yudkin P.L.
        • Vessey M.P.
        • et al.
        Chronic pelvic pain in the community—symptoms, investigations, and diagnoses.
        Am J Obstet Gynecol. 2001; 184: 1149-1155
        • Lessa L.M.
        • Chein M.B.
        • da Silva D.S.
        • et al.
        Irritable bowel syndrome in women with chronic pelvic pain in a Northeast Brazilian city.
        Revist Brasil Ginecol Obstet. 2013; 35: 84-89
        • Coelho L.S.
        • Brito L.M.
        • Chein M.B.
        • et al.
        Prevalence and conditions associated with chronic pelvic pain in women from Sao Luis, Brazil.
        Braz J Med Biol Res. 2014; 47: 818-825
        • Spierings E.L.
        • Padamsee A.
        Menstrual-cycle and menstruation disorders in episodic vs chronic migraine: an exploratory study.
        Pain Med (Malden, Mass). 2015; 16: 1426-1432
        • Yosef A.
        • Allaire C.
        • Williams C.
        • et al.
        Multifactorial contributors to the severity of chronic pelvic pain in women.
        Am J Obstet Gynecol. 2016; 215: 760.e1-760.e14
        • Beutel M.E.
        • Weidner K.
        • Brähler E.
        Chronic pelvic pain of women and its co-morbidity.
        Geburtshilfe Frauenheilk. 2005; 65: 61-67
        • Olafsdóttir L.B.
        • Gudjónsson H.
        • Thjódleifsson B.
        Epidemiological study of functional bowel disorders in Iceland.
        Læknabladid. 2005; 91: 329-333
        • Mayer R.
        • Rothschild J.
        Phenotyping of painful bladder syndrome/interstitial cystitis by pain severity.
        Int Urogynecol J Pelvic Floor Dysfunct. 2011; 22: S1348
        • Özdemir K.
        • Özerdoǧan N.
        • Ünsal A.
        Evaluation of dyspareunia among married women and its impact on quality of life in a urban area of western Turkey.
        Turk Klinik Jinekol Obstet. 2013; 23: 27-35
        • Caetano C.
        • Ferraz Z.
        • Guerra C.
        • Torgal I.
        Mastalgia in young women: influence of other types of gynecological pain and family history of breast cancer.
        Int J Gynecol Obstet. 2015; 131: E129
        • Aromaa M.
        • Sillanpaa M.
        • Rautava P.
        • Helenius H.
        Prevalence of frequent headache in young Finnish adults starting a family.
        Cephalalgia. 1993; 13: 330-337
        • Tchoudomirova K.
        • Mardh P.A.
        • Hellberg D.
        Vaginal microbiological flora, and behavioural and clinical findings in women with vulvar pain.
        BJOG. 2001; 108: 451-455
        • Ferrero S.
        • Pretta S.
        • Bertoldi S.
        • et al.
        Increased frequency of migraine among women with endometriosis.
        Hum Reprod (Oxford, England). 2004; 19: 2927-2932
        • Valencia-Flores M.
        • Cardiel M.H.
        • Santiago V.
        • et al.
        Prevalence and factors associated with fibromyalgia in Mexican patients with systemic lupus erythematosus.
        Lupus. 2004; 13: 4-10
        • Ríos G.
        • Estrada M.
        • Mayor A.M.
        • Vilá L.M.
        Factors associated with tender point count in Puerto Ricans with fibromyalgia syndrome.
        P R Health Sci J. 2014; 33: 112-116
        • de Menezes Couceiro T.C.
        • Valença M.M.
        • Raposo M.C.F.
        • de Orange F.A.
        • Amorim M.M.R.
        Prevalence of post-mastectomy pain syndrome and associated risk factors: a cross-sectional cohort study.
        Pain Manage Nurs. 2014; 15: 731-737
        • Østensjø V.
        • Moen K.
        • Storesund T.
        • Rosén A.
        • Østensjø V.
        • Rosén A.
        Prevalence of painful temporomandibular disorders and correlation to lifestyle factors among adolescents in Norway.
        Pain Res Manage. 2017; : 1-10
        • Carman K.B.
        • Arslantas D.
        • Unsal A.
        • et al.
        Menstruation-related headache in adolescents: point prevalence and associated factors.
        Pediatr Int. 2018; 60: 576-580
        • Miller J.A.
        • Missmer S.A.
        • Vitonis A.F.
        • Sarda V.
        • Laufer M.R.
        • Divasta A.D.
        Prevalence of migraines in adolescents with endometriosis.
        Fertil Steril. 2018; 109: 685-690
        • Markham R.
        • Luscombe G.M.
        • Manconi F.
        • Fraser I.S.
        A detailed profile of pain in severe endometriosis.
        J Endometr Pelvic Pain Disord. 2019; 11: 85-94
        • Bao C.
        • Noga H.
        • Allaire C.
        • et al.
        Provoked vestibulodynia in women with pelvic pain.
        Sex Med. 2019; 7: 227-234
        • Bahrami A.
        • Gonoodi K.
        • Khayyatzadeh S.S.
        • et al.
        The association of trace elements with premenstrual syndrome, dysmenorrhea and irritable bowel syndrome in adolescents.
        Eur J Obstet Gynecol Reprod Biol. 2019; 233: 114-119
        • Cozzolino M.
        • Coccia M.E.
        • Lazzeri G.
        • Basile F.
        • Troiano G.
        Variables associated with endometriosis-related pain: a pilot study using a visual analogue scale.
        Revist Brasil Ginecol Obstet. 2019; 41: 170-175
        • Yunus M.B.
        • Masi A.T.
        • Aldag J.C.
        A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes.
        J Rheumatol Suppl. 1989; 19: 62-71
        • Collett B.J.
        • Cordle C.J.
        • Stewart C.R.
        • Jagger C.
        A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners.
        Br J Obstet Gynaecol. 1998; 105: 87-92
        • Poyhia R.
        • Da Costa D.
        • Fitzcharles M.A.
        Previous pain experience in women with fibromyalgia and inflammatory arthritis and nonpainful controls.
        J Rheumatol. 2001; 28: 1888-1891
        • Alonso C.
        • Loevinger B.L.
        • Muller D.
        • Coe C.L.
        Menstrual cycle influences on pain and emotion in women with fibromyalgia.
        J Psychosom Res. 2004; 57: 451-458
        • van den Berg I.
        • Liem Y.S.
        • Wesseldijk F.
        • Zijlstra F.J.
        • Hunink M.G.
        Complex regional pain syndrome type 1 may be associated with menstrual cycle disorders: a case-control study.
        Complement Ther Med. 2009; 17: 262-268
        • Chung S.D.
        • Liu S.P.
        • Lin H.C.
        • Kang J.H.
        Association of dysmenorrhea with interstitial cystitis/bladder pain syndrome: a case-control study.
        Acta Obstet Gynecol Scand. 2014; 93: 921-925
        • Shaver J.L.F.
        • Wilbur J.
        • Robinson F.P.
        • Wang E.
        • Buntin M.S.
        Women's health issues with fibromyalgia syndrome.
        J Womens Health (15409996). 2006; 15: 1035-1045
        • Tietjen G.E.
        • Bushnell C.D.
        • Herial N.A.
        • Utley C.
        • White L.
        • Hafeez F.
        Endometriosis is associated with prevalence of comorbid conditions in migraine: CME.
        Headache. 2007; 47: 1069-1078
        • Payne L.A.
        • Rapkin A.J.
        • Seidman L.C.
        • Lung K.C.
        • Zeltzer L.K.
        • Tsao J.C.
        Relationships among dysmenorrhea, laboratory pain, and psychological variables in healthy girls and girls with chronic pain.
        Clin Transl Sci. 2014; 7: 222
        • Sloth H.
        • Jorgensen L.S.
        Predictors for the course of chronic non-organic upper abdominal pain.
        Scand J Gastroenterol. 1989; 24: 440-444
        • Costantini R.
        • Affaitati G.
        • Wesselmann U.
        • Czakanski P.
        • Giamberardino M.A.
        Visceral pain as a triggering factor for fibromyalgia symptoms in comorbid patients.
        Pain. 2017; 158: 1925-1937
        • Lim P.F.
        • Smith S.
        • Bhalang K.
        • et al.
        Development of temporomandibular disorders is associated with greater bodily pain experience.
        Clin J Pain. 2010; 26: 116-120
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Shaver J.L.
        • Wilbur J.
        • Robinson F.P.
        • Wang E.
        • Buntin M.S.
        Women's health issues with fibromyalgia syndrome.
        J Womens Health (2002). 2006; 15: 1035-1045
        • Surrey E.S.
        • Soliman A.M.
        • Johnson S.J.
        • Davis M.
        • Castelli-Haley J.
        • Snabes M.C.
        Risk of developing comorbidities among women with endometriosis: a retrospective matched cohort study.
        J Womens Health (2002). 2018; 27: 1114-1123
        • Soliman A.M.
        • Coyne K.S.
        • Zaiser E.
        • Castelli-Haley J.
        • Fuldeore M.J.
        The burden of endometriosis symptoms on health-related quality of life in women in the United States: a cross-sectional study.
        J Psychosom Obstet Gynaecol. 2017; 38: 238-248
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Greene A.D.
        • Lang S.A.
        • Kendziorski J.A.
        • Sroga-Rios J.M.
        • Herzog T.J.
        • Burns K.A.
        Endometriosis: where are we and where are we going?.
        Reproduction. 2016; 152: R63-R78
        • Berkley K.J.
        A life of pelvic pain.
        Physiol Behav. 2005; 86: 272-280
        • Giamberardino M.A.
        • Costantini R.
        • Affaitati G.
        • et al.
        Viscero-visceral hyperalgesia: characterization in different clinical models.
        Pain. 2010; 151: 307-322
        • Woolf C.J.
        Central sensitization: implications for the diagnosis and treatment of pain.
        Pain. 2011; 152: S2-S15
        • Schaible H.G.
        Peripheral and central mechanisms of pain generation.
        Handb Exp Pharmacol. 2007; : 3-28
        • Giamberardino M.A.
        Recent and forgotten aspects of visceral pain.
        Eur J Pain (London, England). 1999; 3: 77-92
        • Granot M.
        • Yarnitsky D.
        • Itskovitz-Eldor J.
        • Granovsky Y.
        • Peer E.
        • Zimmer E.Z.
        Pain perception in women with dysmenorrhea.
        Obstet Gynecol. 2001; 98: 407-411
        • Bajaj P.
        • Bajaj P.
        • Madsen H.
        • Arendt-Nielsen L.
        A comparison of modality-specific somatosensory changes during menstruation in dysmenorrheic and nondysmenorrheic women.
        Clin J Pain. 2002; 18: 180-190
        • Low I.
        • Kuo P.-C.
        • Liu Y.-H.
        • et al.
        Altered brain complexity in women with primary dysmenorrhea: a resting-state magneto-encephalography study using multiscale entropy analysis.
        Entropy. 2017; 19: 680
        • Vachon-Presseau E.
        • Tetreault P.
        • Petre B.
        • et al.
        Corticolimbic anatomical characteristics predetermine risk for chronic pain.
        Brain. 2016; 139: 1958-1970
        • Bourke J.H.
        • Langford R.M.
        • White P.D.
        The common link between functional somatic syndromes may be central sensitisation.
        J Psychosom Res. 2015; 78: 228-236
        • Li X.
        • Hu L.
        The role of stress regulation on neural plasticity in pain chronification.
        Neural Plast. 2016; 2016: 6402942
        • Payne L.A.
        • Rapkin A.J.
        • Seidman L.C.
        • Zeltzer L.K.
        • Tsao J.C.
        Experimental and procedural pain responses in primary dysmenorrhea: a systematic review.
        J Pain Res. 2017; 10: 2233-2246
        • Payne L.A.
        • Seidman L.C.
        • Sim M.S.
        • Rapkin A.J.
        • Naliboff B.D.
        • Zeltzer L.K.
        Experimental evaluation of central pain processes in young women with primary dysmenorrhea.
        Pain. 2019; 160: 1421-1430
        • Bottcher B.
        • Gizewski E.R.
        • Siedentopf C.
        • et al.
        Behavioural and neural responses to aversive visceral stimuli in women with primary dysmenorrhoea.
        Eur J Pain. 2019; 23: 272-284