Reinforced pain catastrophizing during menstrual phase among women with primary dysmenorrhea is mediated by cerebral blood flow in the medial prefrontal cortex

• Published in: The European journal of neuroscience 2024-11, Vol.60 (9), p.6267-6278
• Main Authors: Shang, Meiling, Liu, Huiping, Ma, Ling, Fan, Tongtong, Bai, Weixian, Yang, Jing, Quan, Lu, Zhang, Yuchen, Dun, Wanghuan
• Format: Article
• Language: English
• Subjects: Adult; Amygdala; Blood flow; Catastrophization - physiopathology; Catastrophization - psychology; Cerebral blood flow; Cerebrovascular Circulation - physiology; Chronic pain; Cortex (frontal); dysmenorrhea; Dysmenorrhea - physiopathology; Dysmenorrhea - psychology; Female; Humans; Magnetic Resonance Imaging; medial prefrontal cortex; mediating effect; Menstrual cycle; Menstrual Cycle - physiology; Menstrual Cycle - psychology; Menstruation; pain catastrophizing; Pain Measurement - methods; Prefrontal cortex; Prefrontal Cortex - diagnostic imaging; Prefrontal Cortex - physiopathology; Spin labeling; Young Adult
• ISSN: 0953-816X; 1460-9568; 1460-9568
• DOI: 10.1111/ejn.16545

Pain catastrophizing is a prominent psychological factor that is strongly correlated with pain. Although the complex properties of pain catastrophizing vary across different pain phases, the contribution of chronic pain to its progression from a general trait to a higher state remains unclear. This study aimed to examine the neural mechanisms and degree to which pain catastrophizing is reinforced in the context of primary dysmenorrhea (PDM), one of the most prevalent gynaecological complaints experienced by women of reproductive age. Altogether, 29 women with moderate‐to‐severe PDM were included in this study. Arterial spin labelling was used to quantify the cerebral blood flow (CBF) in each participant in both the pain‐free and painful phases. The pain catastrophizing scale (PCS) was completed in two phases, and the Short‐Form McGill Pain Questionnaire was completed in the painful phase. Compared with pain catastrophizing in the pain‐free phase (PCSpf), pain catastrophizing in the painful phase (PCSp) is higher and positively correlated with the composite factor of menstrual pain. CBF analysis indicated that the PCSp is positively associated with CBF in the frontal cortex, hippocampus and amygdala. The reinforcement of pain catastrophizing correlates with CBF in the prefrontal cortex. Specifically, the medial prefrontal cortex, which correlates with pain state, plays a crucial role in mediating the reinforcing effect of pain in the PCSp. These results promote the mechanical comprehension of pain catastrophizing management in individuals with chronic pain. Reinforced pain catastrophizing during menstrual phase among primary dysmenorrhea females is mediated by cerebral blood flow in the medial prefrontal cortex. In this mediation model, the direct effect from PAIN to PCSp is not significant, while CBF of medial frontal cortex built a causal relationship between them, which leads to a reinforced state of pain catastrophizing in the painful phase of women with primary dysmenorrhea.