Background & Aims
Menarche (first menstruation) is a key developmental period in adolescence and the point where sex disparities in chronic pain prevalence widen.1,2,3 Widespread body pain can emerge in adolescence and is a risk factor for chronic widespread pains in adulthood – such as fibromyalgia.4,5 Population studies indicate mental health, back and visceral pain, and female gender as risk factors for widespread pain development in adolescents.6,7 The mechanisms underlying pain spread to multiple body sites are unknown, although sensitization of the CNS is thought to play a role. Indeed, greater sensitivity to stimuli across modalities (i.e., multimodal hypersensitivity [MMH]) is seen in adults with fibromyalgia8 and prior work in our lab found that MMH predicts future pelvic pain intensity in adult women.9 Here, we aimed to a) identify predictors for developing widespread body pain (pain in at least 3/7 sites) in adolescents and b) investigate potential brain mechanisms underlying pain spread.
Methods
In this longitudinal study, participants (n=178) completed pre- and post-menarchal visits over an average of 2.6 years. Each visit included a bodymap questionnaire to assess pain in 7 body sites as well as other pain and psychosocial questionnaires. Quantitative sensory testing included thresholds for pressure pain, ratings of cold pain, and conditioned pain modulation (a behavioural measure of the brain’s endogenous descending pain modulation system). Provoked bladder pain was measured during a natural water drinking task. Participants also completed a visual sensitivity task in which they rated the unpleasantness of visual stimuli presented at varying intensities on a screen. Concurrent 64-channel EEG was collected to record brain activity during the visual task. Steady-state visually-evoked potentials (SSVEPs) in response to the visual stimuli were analyzed in a subset of participants with useable EEG data (n=136).
Results
One quarter (n=44) of participants had widespread pain at the pre-menarche baseline visit, another quarter (n=45) developed it by the post-menarche visits and half (n=89) did not have widespread pain at any point. Widespread body pain was predicted by higher baseline ratings of average weekly pain, pain interference, and abdominal pain. Menstrual pain was not associated with widespread pain. Baseline psychosocial predictors of developing widespread pain included higher scores of anxiety, depression, somatic symptoms and stress. Neither baseline pressure pain thresholds, cold pain ratings, nor conditioned pain modulation predicted widespread pain development, however, greater bladder pain during the water drinking task did, as did higher unpleasantness ratings for the visual stimuli. Although SSVEP magnitude was correlated to visual unpleasantness, there was no significant effect related to widespread pain after correcting for multiple comparisons.
Conclusions
We identified several baseline predictors of widespread pain development in adolescents across the menarche transition including psychological factors, ratings of weekly pain and its interference in daily life, bladder pain sensitivity, and visual hypersensitivity (a component of MMH). In contrast, responses to experimental pain and the level of menstrual pain were not associated with pain widespreadness. Although they were more sensitive to unpleasant visual stimuli, those with widespread body pain did not display altered SSVEPs, suggesting an alternate neural mechanism associated with their hypersensitivity that is not reflected in initial processing of incoming visual stimuli.
References
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Presenting Author
Natalie R. Osborne
Poster Authors
Natalie Osborne
PhD
Northshore University HealthSystem
Lead Author
Emily Burda
B.Sc.
NorthShore University HealthSystem
Lead Author
Sarah E. Darnell
B.Sc.
NorthShore University HealthSystem
Lead Author
Andrew Schrepf
University of Michigan
Lead Author
Lynn Walker
PhD
Vanderbilt University
Lead Author
Kevin Hellman
Endeavor / Pritzker School Of Medicine, University of Chicago
Lead Author
Frank F. Tu
MD
University of Chicago, NorthShore University HealthSystem
Lead Author
Topics
- Pain in Special Populations: Adolescents