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The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Endometriosis is an estrogen-dependent, chronic gynecological disorder associated with pelvic pain and infertility, with a prevalence of 6 to 10% in the general population.6,7,12 Affected women experience dysmenorrhea, deep dyspareunia, dyschezia, and dysuria12,35 associated with low quality of life.8 The disorder is underdiagnosed or there is a delay in diagnosis in many cases leading to chronic pelvic pain (CPP).7,26 Diagnosis is made using laparoscopy or laparotomy, where endometrial lesions are found in extrauterine locations, mainly the peritoneum and ovaries.

The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Orginally Published At: Pain Journal

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Opposing Roles of Estradiol and Testosterone on Stress-Induced Visceral Hypersensitivity in Rats

Women disproportionately suffer from chronic pain conditions including irritable bowel syndrome (IBS), fibromyalgia, migraine, and temporomandibular joint pain, many of which are comorbid with anxiety or depression disorders.7,9,11,29,37,110 During the past decades, efforts have been made to explore the mechanisms underlying sex differences in stress-induced anxiety and depression (for review, see Bangasser and Valentino8 and McEwen et al72). However, less is known about mechanisms underlying sex differences in stress-induced chronic pain conditions.

Opposing Roles of Estradiol and Testosterone on Stress-Induced Visceral Hypersensitivity in Rats

Orginally Published At: Pain Journal

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Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms

Fibromyalgia (FM) is a complex chronic pain disease, characterized by generalized diffuse musculoskeletal pain.59,76 The worldwide prevalence of FM is estimated between 2% and 4%, and the U.S. incidence is estimated at 6.88 cases per 1,000 people per year for men and 11.28 cases per 1,000 people per year for women.59,71 Diagnosis is difficult, on the basis of clinical signs, and has no specific confirmatory test. As a result, in 1999 the American College of Rheumatology established that diagnosis required pain on digital palpation in 11 or more of 18 specific sites.

Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms

Orginally Published At: Pain Journal

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Neonatal Handling Produces Sex Hormone-Dependent Resilience to Stress-Induced Muscle Hyperalgesia in Rats

Chronic musculoskeletal pain, which is over-represented among women, is a common, debilitating and costly condition, which currently lacks effective treatment.58,61,66 Psychological stress is well established to contribute to the etiopathogenesis of chronic musculoskeletal pain,13,54,62 because it can trigger as well as aggravate these pain syndromes.24,54,62 Despite the importance of these 2 factors, the mechanisms underlying the interaction between sex and stress in chronic musculoskeletal pain remains poorly understood.

Neonatal Handling Produces Sex Hormone-Dependent Resilience to Stress-Induced Muscle Hyperalgesia in Rats

Orginally Published At: Pain Journal

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Disease-Related Microstructural Differences in the Brain in Women With Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is a chronic pelvic pain disorder affecting approximately 16% of women,37 with a significant effect on quality of life.37 Individuals with PVD report localized hypersensitivity and severe pain of the vulvar vestibule upon vaginal penetration (eg, intercourse, tampon use) in the absence of detectable infection or inflammatory etiology.4,31 The underlying pathophysiology of PVD is largely unknown, and treatment options remain unsatisfactory.85 Available evidence suggests that peripheral as well as central alterations in sensory processing appear to be involved.

Disease-Related Microstructural Differences in the Brain in Women With Provoked Vestibulodynia

Orginally Published At: Pain Journal

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Daily Anxiety and Depressive Symptoms in Couples Coping With Vulvodynia: Associations With Women's Pain, Women's Sexual Function, and Both Partners' Sexual Distress

Vulvodynia is a common idiopathic gynecological pain condition. With a prevalence of 8 to 12% in the general population,32,33,60 provoked vestibulodynia (PVD) is the most common subtype and is characterized by a burning pain elicited upon pressure to the vulvar vestibule.7,14,30 This intermittent pain significantly disrupts couples’ sexuality.10,25,29,36,49,56 Controlled studies show that affected women report more sexual distress, poorer sexual function, and feelings of inadequacy as a sexual partner.

Daily Anxiety and Depressive Symptoms in Couples Coping With Vulvodynia: Associations With Women’s Pain, Women’s Sexual Function, and Both Partners’ Sexual Distress

Orginally Published At: Pain Journal

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Women report higher pain intensity at a lower level of inflammation after knee surgery compared with men

imageIntroduction and Objectives:
We previously found that women report more pain after knee arthroscopic procedures than men. It remains unclear whether this is due to different biochemical responses or nociceptive mechanisms.
Methods:
We analyzed acute pain-related inflammatory markers in a clinical model of patient self-reported pain immediately after knee surgery. To simultaneously measure 92 inflammatory biomarkers, we used the proximity extension assay with the Proseek Multiplex Inflammation I panel (Olink Bioscience, Uppsala, Sweden). Knee surgery was performed under general anesthesia with propofol and remifentanil. Analgesic drugs were only administered on patient request.
Results:
Women were 4.9 times more likely to report moderate or severe pain than men (95% confidence interval, 1.2–19.6, P = 0.024). Patient age, preoperative pain, and surgery duration were not significant factors. We analyzed synovial fluids from 44 patients (23 women, 21 men). After false discovery rate correction, MMP-10 was the only biomarker that was higher among men (P = 0.01). Linear discriminant analysis showed that 3 proteins (IL-8, CCL-4, and MCP-2) were expressed at higher levels in men, with differences of >1 normalized protein expression. No proteins were overexpressed by >1 normalized protein expression in women.
Conclusion:
Acute pain after knee arthroscopy was more intense in women, but pro-inflammatory biomarkers and MMP-10 were higher in men. Further knowledge of cytokine function is required before concluding that the disparities in biomarker expression are clinically unimportant. The similar biochemical signaling between sexes suggests that central mechanisms are of greater importance in sex-specific joint pain perception.

Women report higher pain intensity at a lower level of inflammation after knee surgery compared with men


Orginally Published At: PAIN Reports

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Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program

imageThe present study explored whether pain-related psychosocial risk factors played a role in determining whether treatment gains were maintained following participation in a rehabilitation intervention for musculoskeletal injury. The study sample consisted of 310 individuals (163 women, 147 men) with work-related musculoskeletal conditions who were enrolled in a physical rehabilitation program. Measures of pain severity, pain catastrophizing and pain-related fear were completed at the time of admission and at the time of discharge. Pain severity was assessed again at 1-year postdischarge. Participants were classified as “recovered” if they showed a decrease in pain of at least 2 points and rated their pain at discharge as less than 4/10. Recovered participants were considered to have failed to maintain treatment gains if their pain ratings increased by at least 2 points from discharge assessment to 1-year follow-up, and they rated their pain as 4/10 or greater at 1-year follow-up. The results of a logistic regression revealed that participants with high posttreatment scores on measures of catastrophizing and fear of pain were at increased risk of failing to maintain treatment gains. The findings suggest that unless end-of-treatment scores on catastrophizing and fear of pain fall below the risk range, treatment-related reductions in pain severity may not be maintained in the long term. The clinical and theoretical implications of the findings are discussed.

Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program


Orginally Published At: PAIN Reports