The Relationship between Pain and Vascular Function Biomarkers in Dysmenorrheal University Students

Abstract

Our aim was to establish if the secretion of contactin 1 (CNTN-1), a widely researched pain biomarker correlates with the severity of dysmenorrhea and circulating levels of vascular cell adhesion molecule 1 (VCAM-1) and angiotensin II (ANG-II). This study was a longitudinal randomized clinical study that involved 95 female students between 17–25 years. The control participant group were students who, without medications, had not experienced dysmenorrhea, while the inclusion criteria were primary dysmenorrhea without medications. Data was collected using demographic questionnaires that also contained the Numeric Rating Scale (NRS-11), while blood samples were collected for analysis of CNTN-1, VCAM-1 and ANG-II by ELISA. The participants' mean BMI's across the four pain strata were between 16.60–38.43 kg/m 2 and in addition to age and menarche, showed no correlation to either the NRS-11 scale (r=−0.01214) or their CNTN-1 levels (r=0.009622). The severe dysmenorrhea group showed statistically higher (p<0.0001) and positive correlation to systolic (r=0.7304) and diastolic (0.6588) blood pressures. The contactin 1 levels (7.00-55.70 ng/mL) increased with higher menstrual pain and as the pain increased, so did the mean VCAM-1 and ANG-II levels (p<0.0001). A positive linear correlation (r=0.9691) was observed between the NRS-11 scale of the participants and their CNTN-1 activities while the CNTN-1 levels positively correlated with their VCAM-1 (r=0.9334) and ANG-II (r=0.8746) secretion. In summary, the severity of dysmenorrheal pain elevates the contactin 1 levels which affects their vascular health and blood pressure.

Nutritional modulation of blood pressure and vascular changes during severe menstrual cramps

“…Foods consumed prior to or during menstruation influence menstrual outcome. 10 , 11 , 22 Among the reported outcomes of dysmenorrhoea are blood-pressure distortion and vascular health. 23 , 24 However, the degree to which certain foods influence dysmenorrhoea and related outcomes is unscalable, given the lack of reliable biomarkers to classify dysmenorrhoea according to severity of pain.…”

“…In earlier studies, which had smaller sample sizes and lacked well-controlled participants, the consumption of pasta and cereals has been associated with higher levels of menstrual pain 28 . The lack of well-controlled participants and the inability to completely exclude other diets, merely drawing inferences from the fact that carbohydrates constituted the predominant diet in the days before menstruation, may have influenced the outcomes of studies including Dicintio et al., 11 Tavallaee et al., 29 with Iranian women, and Gagua et al., 13 with Georgian women. Protein diets did not have a significant impact on menstrual-flow severity in most participants, except when proteins were consumed over three continuous menstrual cycles.…”

“…A study has now made the association between dysmenorrhoea and the expression of contactin-1 levels. 11 Contactin-1 is a biomarker in the immunoglobulin family, whose expression has been identified in both vasculogenesis and pain sensation. 11 Contactin-1 expressions are associated with the over-secretion of angiotensin-1 and vascular cell adhesion molecules, which are reliable diagnostic biomarkers for vascular health.…”

“… 11 Contactin-1 is a biomarker in the immunoglobulin family, whose expression has been identified in both vasculogenesis and pain sensation. 11 Contactin-1 expressions are associated with the over-secretion of angiotensin-1 and vascular cell adhesion molecules, which are reliable diagnostic biomarkers for vascular health. 11 At the same time, the ‘normal’ perception of dysmenorrhoea and its attendant complications, caused by pain-relief drugs, including sodium diclofenac and ibuprofen, 12 discourages dysmenorrhoeal women from continuing with pharmacological interventions.…”

“… 11 Contactin-1 expressions are associated with the over-secretion of angiotensin-1 and vascular cell adhesion molecules, which are reliable diagnostic biomarkers for vascular health. 11 At the same time, the ‘normal’ perception of dysmenorrhoea and its attendant complications, caused by pain-relief drugs, including sodium diclofenac and ibuprofen, 12 discourages dysmenorrhoeal women from continuing with pharmacological interventions. Other well-documented non-pharmacological methods of relieving menstrual pain include diet interventions, lifestyle adaptations, herbs, and natural supplements.…”