The study will use primary dysmenorrhea (PD; menstrual pain without an identified organic cause) as a model to examine biomarkers associated with menstrual and non-menstrual bodily pain in adolescent girls, ages 13-19. Participants will undergo extensive phenotyping including pain inhibition testing and multimodal neuroimaging to obtain indices brain structure and function at baseline and 12 months later. Menstrual pain severity and non-menstrual bodily pain will be assessed monthly for 24 months. Aims of the study are: 1) to identify the central mechanisms of PD using measures of pain inhibition and brain structure and connectivity of sensorimotor, default, emotional arousal, and salience networks, 2) to determine deficits in pain inhibition and alterations in brain structure and network connectivity that predict the one-year developmental trajectories of menstrual pain and non-menstrual bodily pain, and 3) to identify the dynamic relationship between alterations in pain inhibition and brain structure and connectivity with symptom change in menstrual pain and non-menstrual bodily pain. We hypothesize that deficits in endogenous pain inhibition and alterations in brain structure, connectivity, and function of regional networks will be positively associated with menstrual pain severity ratings at baseline and predict the trajectory of menstrual and non-menstrual bodily pain over 2 years. The results are expected to identify specific mechanisms and characteristics that predict the transition from acute/cyclical pain to persistent or chronic pain, which will support the development of therapies to prevent the transition from recurrent to chronic pain in adulthood.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
164
Quantitative sensory testing (QST) consisting of 4 pain induction and sensory sensitivity tasks (i.e., pressure applied to the thumbnail, arms, shoulders, and lower abdomen, a cold water task, and one video-watching task).
Functional magnetic resonance imaging (fMRI) session consisting of structural and functional brain scans.
McLean Hospital
Belmont, Massachusetts, United States
Menstrual pain
Rating of average pain during the first two days of the most recent menstrual period on a 0 (no pain) to 10 (worst pain possible) numeric rating scale.
Time frame: Baseline
Change in menstrual pain from baseline to 12-months post baseline
Change in the rating of average pain during the first two days of the most recent menstrual period on a 0 (no pain) to 10 (worst pain possible) numeric rating scale.
Time frame: At baseline and 12 months after baseline
Change in bodily pain from baseline to 12-months post baseline
Change in the number of bodily locations endorsed as painful during the prior month.
Time frame: At baseline and 12 months after baseline
Pressure pain sensitivity (PPS)
The pain rating \[on a 0 (no pain) to 100 (worst pain possible) numeric rating scale\] of a 5-second, 2.0 kg/cm2 application of pressure to the right thumbnail bed.
Time frame: At baseline
Pressure pain tolerance (PPT)
The last rated pressure delivered in a series of increasing pressure applications to the right thumbnail bed. Each application of pressure lasts for 5 seconds. The pressure sequence is terminated when the participant reaches their individual tolerance and decides to stop, when the participant reaches the safety maximum amount of pressure, or when the participant rates the pressure \>=80 on a 0 (no pain) to 100 (worst pain possible) numeric rating scale.
Time frame: At baseline
Trapezius pressure pain threshold (TPPTh)
The amount of pressure, applied by a pressure algometer to the participant's trapezius muscle, needed for the pressure stimulus to first feel painful to the participant.
Time frame: At baseline
Conditioned pain modulation (CPM)
Conditioned pain modulation (CPM) assesses pain inhibition. CPM is calculated as the change in the TPPTh between when the pressure is applied by itself (test stimulus) and when it is applied while the participant's hand is submerged in cold water (conditioning stimulus).
Time frame: At baseline
Gray matter volume
Gray matter regional volume and surface area will be measured from images obtained during the fMRI session.
Time frame: At baseline
White matter fiber tract values
Obtained from fiber tracking using images obtained during diffusion tensor imaging (DTI). Values represent anatomical connectivity of cortical and subcortical brain regions.
Time frame: At baseline
Resting state networks
Calculated from images obtained during resting state fMRI. Region-to-region connectivity indices are obtained by correlating fMRI time series corrected for physiological noise and motion. Region-to-region connectivity strength of the regions of interest (i.e., salience, sensorimotor, emotional arousal, and default mode networks) will be assessed for each participant.
Time frame: At baseline
Change in menstrual pain from 12-months post baseline to 24-months post baseline
Change in the rating of average pain during the first two days of the most recent menstrual period on a 0 (no pain) to 10 (worst pain possible) numeric rating scale.
Time frame: 12 months after baseline and 24 months after baseline
Change in bodily pain from 12-months post baseline to 24-months post baseline
Change in the number of bodily locations endorsed as painful during the prior month.
Time frame: 12 months after baseline and 24 months after baseline
Salivary pro-inflammatory cytokines
Assessment of pro-inflammatory cytokines found in the saliva (e.g., IL-1 Beta, IL-6, IL-8, TNF-Alpha)
Time frame: Three time points during each of two study visits: during questionnaire completion (approx. 20 min. after arrival), immediately after the imaging session (approx. 90 min. after arrival), and following the final pain task (approx. 120 min after arrival)
Trapezius pressure pain threshold (TPPTh)
The amount of pressure, applied by a pressure algometer to the participant's trapezius muscle, needed for the pressure stimulus to first feel painful to the participant.
Time frame: 12 months after baseline
Change in conditioned pain modulation (CPM) from baseline to 12-months post baseline
Alterations in pain inhibition will be assessed via the direction of the change (i.e., improvement in pain inhibition, worsening of pain inhibition, and stable pain inhibition) as well as the magnitude of the change.
Time frame: At baseline and 12 months after baseline
Change in pressure pain sensitivity (PPS) from baseline to 12-months post baseline
Change in the pain rating \[on a 0 (no pain) to 100 (worst pain possible) numeric rating scale\] of a 5-second, 2.0 kg/cm2 application of pressure to the right thumbnail bed.
Time frame: At baseline and 12 months after baseline
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Change in pressure pain tolerance (PPT) from baseline to 12-months post baseline
Change in the PPT described above between baseline and 12-months post baseline.
Time frame: At baseline and 12 months after baseline
Change in gray matter volume from baseline to 12-months post baseline
Change in the gray matter regional volume and surface area obtained from images obtained during the fMRI session.
Time frame: At baseline and 12 months after baseline
Change in white matter fiber tract values from baseline to 12-months post baseline
Change in the DTI-produced fiber tracking values, which represent anatomical connectivity of cortical and subcortical brain regions.
Time frame: At baseline and 12 months after baseline
Change in resting state networks
Change in region-to-region connectivity strength of the regions of interest (i.e., salience, sensorimotor, emotional arousal, and default mode networks).
Time frame: At baseline and 12 months after baseline