Background & Aims
In adults, dysmenorrhea often coexists with other chronic pain syndromes (CPS) and is associated with enhanced sensitivity to pain and reduced quality of life (QoL)(1–7.) There is little data for adolescents, yet dysmenorrhea is a common cause of recurring pain in young patients, for many as early as 10 years old. The prevalence of moderate/severe menstrual pain in adolescents has been reported to range from 12% to 40%. Severe dysmenorrhea interfering with school or activities is estimated to occur in 5% to 15% of teens (8-10). However, pain measures and populations are not uniform across studies, and they do not report on co-existing CPS. This study aims to retrospectively evaluate the prevalence of dysmenorrhea in adolescents with CPS and to consider its role in central nervous system (CNS) sensitization.
Methods
All patients seen at the Boston Children’s Hospital Multidisciplinary Pain Treatment Clinic completed an electronic questionnaire that included a brief, standardized menstrual history to screen for dysmenorrhea, and data about pain, medical history, and psychological function.
Participants: Postmenarchal females <21 years seen at the pain clinic between 2014-2022. Exclusions: endometriosis diagnosis. Measures: The menstrual history asked “How do you rate your menstrual cramps?" Options ranged from severe, moderate, mild or none. Dysmenorrhea was defined as cramps rated moderate and severe. Pain data was collected using a body map. Analysis: Descriptive statistics were calculated and comparisons between patients with and without dysmenorrhea were calculated using t-tests or chi-square, for continuous and categorical variables respectively.
Results
Of the 4610 patients with chronic pain, 3556 (77%) were females. Of these, 744 (20%) were pre-menarchal, 228 (6.4%) had a known endometriosis diagnosis. 109 (3%) were > 21 years and 40 (1%) did not provide information and were thus excluded. Our final sample included 2435 patients. The median age was 16 years (IQR 14.5-17.3). Of these 2435 patients, 268 (11.0%) reported having no cramps; 675 (27.7%), reported their cramps as being mild; 923 (37.9%), as moderate; and 569 (23.3%), as severe. Therefore, 61.2% reported dysmenorrhea. Adolescents with dysmenorrhea more frequently reported pain in >2 locations (8.0% vs. 4.9%, p=0.009), abdominal pain (18% vs. 12%, p=0.003), and endorse clinically significant scores of poor QoL in the social (53.5% vs. 44.5%; p-value< 0.001), emotional (54.7% vs. 63.7%, p-value<0.001) and school (75.2% vs. 65.3%; p-value<0.001) subscales. The worst pain reported by both groups was extremity/joint pain (70.6% with dysmenorrhea and 76.3% without).
Conclusions
Dysmenorrhea was a comorbidity in 61% of adolescents with chronic pain who were evaluated in a Multidisciplinary Pediatric and Adolescent Pain Clinic. While dysmenorrhea is associated with abdominal/pelvic pain, most patients presented for evaluation of musculoskeletal pain (e.g., CRPS, fibromyalgia). Like adults, this study indicates that adolescent dysmenorrhea co-occurs with other chronic pain syndromes (9,10). The effect of a recurring monthly painful event on the development of CNS sensitization in adolescents with chronic pain needs further investigation. This study underscores the importance of a standardized menstrual history in adolescents with chronic pain.
References
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