Pain Sensitivity in Women with Premenstrual Dysphoric Disorder: A Preliminary Report

Abstract

Objective: An impairment in endogenous opioid and/or serotonergic activity during the luteal phase may play a role in the etiology of premenstrual dysphoric disorder (PDD). This study tested the hypothesis that because of these alterations, PDD patients would exhibit greater pain sensitivity than non-PDD controls when tested during the luteal phase of their menstrual cycles. Participants: Seven subjects prospectively diagnosed with PDD and 11 healthy controls participated in the experiment. Design: After completing the Prospective Report of the Impact and Severity of Menstrual Symptoms (PRISM) calendar for 2 months for diagnostic purposes, all subjects underwent thermal and ischémie pain testing during the luteal phase of their menstrual cycles. Results: PDD subjects were significantly more sensitive to ischémie pain than were controls, with PDD subjects exhibiting lower ischémie pain onset and ischémie pain tolerance. PDD subjects also described their ischémie pain as more intense than did controls. No differences in thermal pain perception emerged. Conclusions: These results support the hypothesis that women suffering from PDD exhibit greater ischémie pain sensitivity compared with non-PDD controls. Several mechanisms may underlie this difference.

The Alteration of Pain Sensitivity at Disease-Specific Acupuncture Points in Premenstrual Syndrome

“…Subsequently, several studies have focused on the relationship between the menstrual cycle and pain sensitivity in dysmenorrheic women. However, the results have differed among studies, with some reporting a dysmenorrheal-induced increase in sensitivity in all menstrual phases [15] or during the luteal phase [16], others showing decreased sensitivity during the follicular phase [17], and still others indicating no differences [18]. In light of the prior studies, one may wonder whether the pain threshold at the APs in the present study is influenced by the menstrual cycle.…”

Nociceptive Processing in Women With Premenstrual Dysphoric Disorder (PMDD)

“…By contrast, 2 studies did find PMDD-related hyperalgesia on measures of threshold/ tolerance, but the effect sizes for group differences on pain ratings tended to be even larger than the effect sizes for threshold/tolerance measures. 2,3 This suggests that PMDD may affect the retrospective report of pain more so than threshold/tolerance measures, perhaps due to PMDDrelated affect influencing memory for pain more so than real-time evaluation of painful stimuli. 44 Two additional pain-related observations from the present study are worth noting.…”

“…1 Interestingly, pain processing may be disrupted in PMDD. Specifically, laboratory studies suggest PMDD is associated with lower ischemic pain thresholds/tolerances, [2][3][4] in addition to greater ischemic, 4 pressure, 5 and cold pressor pain intensity ratings, 4 when compared with healthy control women. Moreover, it appears this PMDD-related hyperalgesia may not be phase-dependent (ie, not during late-luteal phase only); rather, it persists throughout the menstrual cycle.…”

The Effects of Mindfulness-Based Cognitive Therapy on Depression and Anxiety in Women with Premenstrual Syndrome

“…To date, no randomized, controlled, prospective trial assessing the effectiveness of MBCT in patients with PMS has been published. Previous research has shown that women with severe PMS exhibit dysregulation in cardiovascular stress reactivity [30] and greater sensitivity to pain stimuli than women without severe PMS [31]. Consequently, we hypothesized that MBCT may improve sensitivity to pain, mood irritability, and stress reactivity in women with PMS.…”