Abnormal cerebral metabolism during menstrual pain in primary dysmenorrhea

Primary dysmenorrhea (PDM, menstrual pain without pelvic abnormality) is the most common gynecological disorder for women in the reproductive age. It is characterized by cramping pain and enhanced pain sensitivity during the menstruation period. PDM has been associated with peripheral and central se...

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Published inNeuroImage (Orlando, Fla.) Vol. 47; no. 1; pp. 28 - 35
Main Authors Tu, Cheng-Hao, Niddam, David M., Chao, Hsiang-Tai, Liu, Ren-Shyan, Hwang, Ren-Jen, Yeh, Tzu-Chen, Hsieh, Jen-Chuen
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.08.2009
Elsevier Limited
Subjects
Abdomen
Adult
Antidepressants
Anxiety
Brain - diagnostic imaging
Brain - physiopathology
Brain Mapping
Dysmenorrhea - physiopathology
Estradiol - blood
Female
Glucose - metabolism
Humans
Menstrual Cycle - physiology
Menstruation
Menstruation - physiology
Metabolism
Multivariate Analysis
Neuropsychological Tests
Pain - etiology
Pain - physiopathology
Pain Measurement
Patients
Positron-Emission Tomography
Studies
Women
Young Adult
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Summary:Primary dysmenorrhea (PDM, menstrual pain without pelvic abnormality) is the most common gynecological disorder for women in the reproductive age. It is characterized by cramping pain and enhanced pain sensitivity during the menstruation period. PDM has been associated with peripheral and central sensitization. Abnormal brain mechanisms may further contribute to development and maintenance of the state. Using fluoro-deoxyglucose positron emission tomography, increased activity was observed in prefrontal/orbitofrontal regions and left ventral posterior thalamus while decreased activity mainly was observed in sensorimotor regions of the left hemisphere at onset compared to offset of PDM. These results were specific to menstrual pain and were not found in menstrual matched controls. Orbitofrontal activities were positively related to while somatosensory activities where negatively related to subjective pain ratings. These results show that ongoing menstrual pain in PDM is accompanied by abnormal brain metabolism. Disinhibition of thalamo-orbitofrontal-prefrontal networks may contribute to the generation of pain and hyperalgesia in PDM possibly by maintaining spinal and thalamic sensitization while increasing negative affect. Excessive excitatory input during menstrual pain may induce compensatory inhibitory mechanism in several somatic sensorimotor regions.
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ISSN:1053-8119
1095-9572
DOI:10.1016/j.neuroimage.2009.03.080