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Ecological Momentary Assessment of Non-Menstrual Pelvic Pain: Potential Pathways of Central Sensitization in Adolescents and Young Adults with and without Primary Dysmenorrhea

Authors Seidman LC, Temme CR, Zeltzer LK, Rapkin AJ, Naliboff BD, Payne LA

Received 22 September 2020

Accepted for publication 10 November 2020

Published 22 December 2020 Volume 2020:13 Pages 3447—3456


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Robert B. Raffa

Laura C Seidman,1 Catherine R Temme,1 Lonnie K Zeltzer,2 Andrea J Rapkin,3 Bruce D Naliboff,4 Laura A Payne1,5

1Division of Women’s Mental Health, McLean Hospital, Belmont, MA, USA; 2Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 3Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 4Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 5Department of Psychiatry, Harvard Medical School, Boston, MA, USA

Correspondence: Laura C Seidman
McLean Hospital, Mail Stop 306, 115 Mill Street, Belmont, MA 02478, USA
Tel +1 617 855 2746

Purpose: Primary dysmenorrhea (PD; menstrual pain without an identified organic cause) has been proposed as a possible risk factor for the development of chronic pelvic pain, but the mechanism through which this process occurs is unknown. One possible mechanism is central sensitization – alterations in the central nervous system that increase responsiveness to pain leading to hypersensitivity. Repeated episodes of pain, such as those experienced over time with PD, may alter how the brain processes pain. Ecological momentary assessment (EMA; collection of data in real time in participants’ natural environments) is a novel data collection method that may help elucidate pain occurring during non-menstrual cycle phases.
Patients and Methods: The current observational study assessed the feasibility and acceptability of using EMA via text messages to collect pelvic pain data during menstrual and non-menstrual cycle phases in a community sample of adolescents and young adults (AYA) aged 16– 24 years with and without PD and explored occurrence rates and intensity of non-menstrual pelvic pain (NMPP) in each of these groups.
Results: Thirty-nine AYA with PD and 53 healthy controls reported pelvic pain level via nightly text message. Global response rate was 98.5%, and all participants reported that the EMA protocol was acceptable. AYA with PD reported higher intensity (2.0 vs 1.6 on 0– 10 numeric rating scale; p=0.003) and frequency (8.7% vs 3.1% of days; p=0.004) of NMPP compared to healthy controls.
Conclusion: The EMA protocol was feasible and acceptable. Though both the intensity and frequency of NMPP were low and at levels that would not typically warrant clinical assessment or intervention, these repeated nociceptive events may represent a potential mechanism contributing to the transition from cyclical to chronic pelvic pain in some individuals.

Keywords: ecological momentary assessment, primary dysmenorrhea, menstrual pain, adolescents and young adults, central sensitization

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