Dissertations / Theses on the topic 'Menstrual pain'

Animal research has elucidated the neurobiological substrates and environmental determinants of pain modulation. Despite these advances, relatively little is known about how psychological processes activate pain modulatory systems. One psychological process that is thought to play an important role in regulating pain sensitivity is emotion. In addition, previous research into the human menstrual cycle and the animal estrous cycle have determined that either the presence of certain gonadal hormones or the fluctuations of these hormones may lead to changes in how females perceive pain, regulate emotion, and modulate pain. The present study examines both the role of emotion and the human menstrual cycle in pain modulation. Participants were 39 female undergraduate students with a mean age of 18.7 years (SD=1.46). Results are consistent with prior studies indicating that progesterone has antiinflammatory effects. Specifically, significant effects were observed primarily in the luteal phase. Subjects in the luteal phase demonstrated less sympathetic arousal during the experiment but greater autonomic arousal during the noise stressor. Participants in the luteal phase also demonstrated an analgesic/anti-inflammatory response evidenced by an observed decrease in secondary hyperalgesia for those that did not receive the noise stressor. No such changes in pain perception were discovered in the ovulation and follicular phases. Finally, in response to the noise stressor, an inhibition of the analgesic/anti-inflammatory effects was observed in the luteal phase. No such evidence of stress-induced pain modulation was discovered in the ovulation and follicular phases. Although the specific mechanisms of this action still remain unclear, prior evidence points to the role of centrally-mediated pain modulation. It is likely that the stressor worked to inhibit the anti-inflammatory effects commonly observed in the luteal phase to persistent inflammatory pain through centrally-mediated pain modulatory mechanisms. It is hypothesized that hormone-mediated effects at the level of the amygdala influenced the impact of affective pain modulation.

There are few data available about the menstrual patterns of Australian teenagers and the prevalence of menstrual disorder in this age group. Aims To establish the typical experience of menstruation in a sample of 16-18 year old women attending ACT Secondary Colleges of Education. To determine the number of teenagers experiencing menstrual disorder that could require further investigation and management. Method The MDOT questionnaire was used to survey participants about their usual pattern of menstruation, signs and symptoms experienced with menses and how menstruation affected various aspects of their lives including school attendance, completion of school work, relationships, social, sexual and physical activity. Data analysis included exploration of aggregated data, as well as individual scrutiny of each questionnaire to determine menstrual disturbance requiring follow up. Those participants whose questionnaire indicated a requirement for further investigation, and who consented to being contacted, were followed up through an MDOT Clinic. Results One thousand and fifty one (1,05 1) completed questionnaires - 98% response rate. The typical experience of menstruation in the MDOT sample includes: bleeding patterns within normal parameters for this age group; menstrual pain, 94%; cramping pain, 71 %; symptoms associated with menstruation, 98.4%; PMS symptoms, 96%; mood disturbance before or during periods, 73%; school absence related to menstruation, 26%; high menstrual interference on one or more life activity, 55.8%; asymptomatic menstruation, 1 %; True response to 'My periods seem pretty normal' 7 1.4%. Statistically significant associations were found between each and all of: menstrual pain, symptoms, interference on life activities and school absence. The prevalence of significant menstrual disturbance in the sample is approximately 25% where: 2 1 % experienced severe pain; 26% reported school absence; 33% had seen a GP about periods; 26.9% think there is something wrong with periods; 23.5% require follow up based on individual scrutiny of each questionnaire; 10- 14% require further investigation to rule out endometriosis. Referral and investigation of menstrual pain, symptoms, and diagnosis of menstrual pathology in the sample was low. Conclusion The MDOT questionnaire has helped to establish a clearer picture of typical menstruation in the population sample. Where 1% of girls reported having asymptomatic menstruation, the majority of teenagers in the study reported menstrual pain and symptoms that could be experienced as part of the dysmenorrhoeic syndrome of symptoms, PMS, or underlying pathology such as endometriosis. Due to the overlap in symptoms and a propensity to be dismissive of menstrual pain and symptoms, many girls are suffering menstrual morbidities that could be well managed with NSAIDs and the oral contraceptive pill (OCP) if non-pathological, or investigated further if a menstrual pathology is suspected. Considering these results the reported school absence rate of 26% is not surprising. Whilst this study does not cost the true impact of menstrual disturbance on schooling, the results of the MDOT questionnaire reflect significant physical and emotional impact on a considerable number of teenager's lives which could also have repercussions on education, schooling performance and other areas of their lives. Future research is planned to determine the MDOT questionnaire's validity for identifying pathological menstrual disorder so it can act as a screening tool to facilitate earlier detection. Replication of the MDOT study should be done in younger teenagers (from menarche) to determine menstrual disturbance in the younger age group.

This study examined the differences in pain perception and pain pressure threshold between the premenstrual phase of the menstrual cycle and the days of the cycle which are not menstrual or premenstrual. Over 2 complete menstrual cycles, 20 volunteer subjects with no known disabilities or illness reported pain assessed by visual analogue scale (VAS) and pressure threshold measures collected 5 times (intervals) for each cycle. A two-factor repeated measures analysis of variance (i.e. cycle, interval and the interaction) revealed only a significant difference across interval for both pain perception (VAS) (F = 15.3146, (4,76), p < .01), and pain pressure threshold (F = 12.0367, (4,76), p < .01). The premenstrual VAS mean scores were significantly higher and pain threshold mean scores significantly lower than the means during the remainder of the cycle in Tukey "A" post-test comparisons. Findings indicate therapists should consider pain perception and potential motivational changes of women during the premenstruum when developing or instituting physically demanding protocols.

Orientador: Maria Cecilia Ferraz de Arruda Veiga
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A mialgia mastigatória, é um dos principais sintomas em pacientes com disfunção temporomandibular (DTM); entretanto, sua patofisiologia ainda é pouco compreendida. Por isso, os objetivos deste trabalho foram investigar o efeito do sexo e do ciclo menstrual na atividade eletromiográfica (EMG) de pacientes com DTM, e a sensibilidade dolorosa, assim como os aspectos psicológicos destes mesmos pacientes. As respostas avaliadas, foram comparadas com as respostas do grupo controle. Os grupos DTM, foram compostos por 30 mulheres com ciclo menstrual regular; e por 23 homens. Os grupos controle, foram compostos por 30 mulheres com ciclo menstrual regular e por 30 homens, ambos sem DTM ou outras dores crÃ'nicas. Os voluntários foram avaliados, com base no Critério Diagnóstico de Pesquisa para DTM, (RDC/TMD) tanto para dor miofascial, como para artralgia (Eixo I). Os voluntários preencheram a Escala do Grau de Dor CrÃ'nica (GCPS), e as escalas de depressão e de sintomas físicos não-específicos (somatização) do RDC/TMD (Eixo II). A atividade EMG no repouso, foi registrada bilateralmente, nos músculos temporal anterior e músculos masseteres. A raiz quadrada da média (RMS) foi gerada a partir dos sinais EMG e foram normalizados, a partir dos valores obtidos durante a contração voluntária máxima. Os resultados mostraram diferenças EMG apenas nos músculos do lado esquerdo dos homens com DTM. Não houve diferenças significativas na atividade EMG dos músculos mastigatórios entre mulheres com e sem DTM. A dor miofascial foi maior na fase menstrual, comparada com as outras fases do ciclo menstrual. Além disso, as mulheres com DTM apresentaram maior GCPS, maior grau de depressão (moderado a severo), e pontuaram maiores itens de somatização (moderado a severo), comparado aos homens com DTM. Concluiu-se portanto, que: 1) Os homens com DTM apresentaram maior atividade EMG nos músculos do lado esquerdo da face, onde a dor foi mais prevalente. Não houve alteração na atividade EMG dos músculos mastigatórios de mulheres com DTM, sugerindo que existam diferenças sexuais nas respostas musculares induzidas pela dor; 2) a dor por DTM, é freqüentemente acompanhada por aspectos psicológicos, como depressão e somatização, principalmente em mulheres
Abstract: The masticatory myalgia is one of the most common symptoms in temporomandibular disorder (TMD) patients; however, its pathophysioloy is poorly understood. Thus, the aims of this study were to investigate the effect of sex and pain on electromyographic activity (EMG); the effect of menstrual cycle phases on EMG activity; the influence of menstrual cycle on pain sensitivity; and the psychological aspects of TMD and control group. TMD cases were 30 normally cycling women; and 23 men. Controls were 30 normally cycling women and 30 men, without TMD or other chronic pains. The subjects were assessed based on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for both myofascial pain and arthralgia (Axis I). Subjects completed the RDC/TMD (Axis II), for Graded Chronic Pain Scale (GCPS), and measures of depression and nonspecific physical symptoms. EMG signals at rest were recorded bilaterally from the anterior temporal and masseter muscles. The root mean square (RMS) were computed from the EMG signals and normalized to the values obtained during maximal voluntary contractions. The results showed that were EMG differences only on the menâ?¿s TMD left masticatory muscles. There were no statistically significant differences in the EMG activity of masticatory muscles between women with and without TMD. The myofascial pain was significantly higher in menstrual phase compared with all of other phases of the menstrual cycle. Moreover, TMD women experienced higher GCPS, more moderately to severely graded depression, and scored greater moderate and severe somatization items than men TMD patients. It was concluded that: 1) The TMD men, presented higher EMG activity on the left side of the face, where pain was more prevalent. There was no significantly differences in EMG activity of womenâ?¿s TMD masticatory muscles, which indicates that the pain-induced changes in muscular responses could differ in men and women; 2) TMD pain is frequently accompanied by psychological aspects, like depression and somatization mainly in women
Doutorado
Fisiologia Oral
Doutor em Odontologia

Orientador: Renata Cunha Matheus Rodrigues Garcia
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Disfunções temporomandibulares (DTM) são condições orofaciais patológicas comuns caracterizadas por dor na articulação temporomandibular e/ou nos músculos da mastigação. A DTM é uma condição comum de dor, especialmente em mulheres durante a fase reprodutiva. Desta maneira os objetivos dessa tese foram (1) avaliar se as flutuações hormonais ocorridas durante o ciclo menstrual alteram a sensibilidade dolorosa (SD), força máxima de mordida (FMM) e performance mastigatória (PM) de voluntárias com DTM, (2) avaliar se os movimentos mandibulares e a qualidade do sono alterariam com o tratamento com placas oclusais estabilizadoras e (3) comparar o diagnóstico baseado no Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) avaliando a confiabilidade e calibração entre o treinamento formal em relação a autoinstrução com documentos e filme. Para tanto, cinquenta voluntárias foram selecionadas e divididas em dois grupos de 25 participantes: (1) voluntárias com DTM e ciclos menstruais regulares e (2) voluntárias com DTM e utilizando contraceptivos orais. Foram analisados a sensibilidade dolorosa (SD) por meio da escala visual analógica, força máxima de mordida (FMM) por meio de sensores e performance mastigatória (PM) por meio do peneiramento. Essas variáveis foram avaliadas durante o período de quatro fases de um ciclo menstrual completo. As mesmas 50 voluntárias diagnosticados com SD participaram do segundo estudo, que foram analisadas a intensidade da dor (escala visual analógica), qualidade do sono (Escala de Sonolência Epworth (ESS) e Índice de Qualidade de Sono de Pittsburgh (PSQI), e movimentos mandibulares ¿ amplitude de movimento e movimentos mastigatórios (cinesiografia) antes e depois de dois meses do tratamento com placa estabilizadora. Medidas repetidas GLIMMIX foram utilizados para a análise de dados seguido pelo teste de Tukey (P ? 0,05). Para o terceiro estudo foi utilizada uma amostra diferente, um total de 32 indivíduos (27 pacientes com DTM e 9 assintomáticos) foram examinados por meio do DC/TMD. Seis examinadores foram divididos em dois grupos com diferentes tipos de treinamento, (1) treinamento formal e de calibração em um centro de treinamento para o DC/TMD e (2) autoinstrução com o uso de documentos e vídeo. Após a primeira avaliação o segundo grupo passou pelo treinamento formal, sendo considerado o grupo (3) Autoinstrução + curso. A avaliação da confiabilidade foi realizada ao longo de um dia inteiro compreendendo em um exame clínico em 16 pacientes para cada um dos três grupos. O coeficiente kappa foi utilizado para calcular a confiabilidade dos diagnósticos do DC/TMD. Em relação aos resultados, foram encontradas diferenças na SD entre a fase lútea (quarta avaliação) e ovulatória (terceira avaliação) (p = 0,01), de ambos os grupos. Não foram encontradas diferenças em FMM (P = 0,34) ou PM (P = 0,43), entre os grupos experimental e controle. Sensibilidade à dor foi reduzido após o tratamento (P = 0,0001). O tratamento melhorou a amplitude de movimento, aumentando a abertura bucal (P = 0,0001) e movimento ântero-posterior (P = 0,01), bem como a velocidade de abertura máxima (P = 0,0001) e de fechamento (P = 0,04) durante a mastigação, após o tratamento. Houve diferenças nos índices de qualidade de sono para PSQI (P = 0,0001) e ESS (P = 0,04) após o tratamento da dor miofacial. No terceiro estudo, a confiabilidade foi boa em todos os três grupos de examinadores para todos os diagnósticos, exceto para a mialgia local e dor miofascial com referência no grupo Autoinstrução + curso. O curso melhorou a confiabilidade para a mialgia e artralgia quando comparado com a auto-instrução. Desta maneira, flutuações de estrogênio pode influenciar a sensibilidade à dor de pacientes com DTM, mas não afeta a função mastigatória. O tratamento de indivíduos com dor miofascial com placas estabilizadoras foi eficaz reduzindo a dor, e esta opção de tratamento melhora a qualidade do sono e movimentação mandibular. A confiabilidade da calibração do DC/TMD por meio do treinamento formal e da auto-instrução são semelhantes, exceto para os subgrupos de Mialgia. A auto-instrução seguida de treinamento formal melhora a confiabilidade da calibração do DC/TMD
Abstract: Temporomandibular disorders (TMD) are common chronic orofacial pathology conditions characterized by pain in the temporomandibular joint and/or muscles of mastication. The TMD is a common pain condition, especially in women during their reproductive phase. Thus the objectives of this thesis were (1) to evaluate whether the hormonal fluctuations that occur during the menstrual cycle alter pain sensitivity (PS), maximum bite force (MBF) and masticatory performance (MP) to volunteers with TMD, (2) evaluate if jaw movements and sleep quality would change with treatment with stabilizing occlusal splint and (3) compare the diagnosis based on the Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) to evaluate the reliability and calibration between formal training in relation to self-instruction with documents and film. For this purpose, fifty volunteers were selected and divided into two groups of 25 participants: (1) volunteers with regular menstrual cycles and TMD, and (2) voluntary with TMD and using oral contraceptives. Pain sensitivity (PS) by using a visual analog scale, maximum bite force (MBF) using sensors and masticatory performance (MP) through screening were analyzed. These variables were measured for a period of four phases of a complete menstrual cycle. The same 50 volunteers diagnosed with PS participated in the second study, pain intensity (visual analogue scale), quality of sleep (Epworth Sleep Scale (ESS) and Index of Pittsburgh Sleep Quality (PSQI) were analyzed, and mandibular movements - range of motion and chewing movements (kinesiography) before and after two months of treatment with stabilizing splints. Repeated measures GLIMMIX were used for data analysis followed by Tukey¿s test (P ? .05). For the third study a different sample was used, a total of 32 patients (27 patients with TMD and 9 asymptomatic) were examined using DC/TMD. Six examiners were divided into two groups with different training, (1) formal training and calibration at a DC/TMD training center and (2) self-instruction with the use of documents and video. After the first evaluation, the second group went through the formal training, considered the group (3) self-instruction + course. The reliability assessment was performed over a full day comprising in a clinical examination of 16 patients for each of the three groups. The Cohen's kappa coefficient was used to calculate the reliability of the DC/TMD diagnoses. Regarding the results, differences between the PS in luteal phase (Fourth evaluation) and ovulatory phase (third evaluation) were found (p = 0.01) in both groups. No differences in MBF (P = 0.34) or MP (P = 0.43) were found between the experimental and control groups. Sensitivity to pain was reduced after treatment (P = 0.0001). The treatment improved range of motion, increasing mouth opening (P = 0.0001) and anterior-posterior movement (P = 0.01) and the maximum opening speed (P = 0.0001) and closing (P = 0.04) during mastication after treatment. There were differences in the sleep quality scores for PSQI (P = 0.0001) and ESS (P = 0.04) after the treatment of myofascial pain. On the third study, the reliability was good in all three groups of examiners for all diagnoses, except for Myofascial pain with referral in the Self + course group. The course group improved reliability for myalgia and arthralgia compared to self-instruction. Thus, estrogen fluctuations may influence the pain sensitivity of TMD patients, but does not affect masticatory function. Treatment of MFP subjects with stabilized splints was effective reducing pain, and this treatment option improves sleep quality and jaw motion. The reliability of the calibration of DC / TMD through formal training and self-education are similar, except for subgroups of Myalgia. The self-instruction followed by formal training improves the reliability of the calibration of DC / TMD
Doutorado
Protese Dental
Doutora em Clínica Odontológica

Menstrual health management can be a difficulty for menstruating women and girls, especially in low- and middle-income countries or other areas of poverty. Menstruation being characterized by stigmatisation, myths and taboo makes it especially troublesome, preventing women and girls to handle their menstruation safely and with dignity. Male attitudes have been argued to play an important role in perpetuating these stigmas and taboos, yet little is known about them. This study sets out to investigate male menstrual knowledge and attitudes, the role of religion in shaping menstrual attitudes and the potential consequences for menstruating women and girls. Qualitative data from group interviews with 24 boys aged 15-19 in a Senior High School in Accra, Ghana is used as basis for analysis. The results are organised along three themes, reflecting the three sub-research questions guiding the study. Findings demonstrate how schoolboys have an elemental understanding of the physiological process of menstruation yet demonstrate a deep understanding of cultural restrictions and the way menstruation may be experienced. Attitudes contain both positive and negative elements, including menstruation as normal and natural on the one hand, and the menstruating girl as unclean and impure on the other. Religion seem to play in important role in perpetuating negative menstrual attitudes, reinforcing the idea of menstruation as impure and unclean. Potential consequences of these attitudes risk menstruation continuing being considered as unclean and impure in addition to be neglected as a “girl’s matter”. However, respondents also identified menstrual difficulties which may foster supportive involvement in menstruation. The findings suggest the importance of continuing to address the surrounding communities of menstruating women and girls, including within and outside of educational and religious institutions.

A diferença da percepção álgica entre homens e mulheres é, há muito, conhecida e documentada na literatura. Sabe-se também que a sensibilidade feminina varia durante o ciclo menstrual, o que levou à hipótese de que os hormônios ovarianos poderiam estar envolvidosnesse processo. Assim, este estudo teve como objetivo investigar os limiares de sensibilidade somestésica (térmica, dolorosa, tátil, vibratória e elétrica), gustativa e olfativa durante o ciclo menstrual de mulheres saudáveis e a sua relação com as concentrações dos hormônios estrógeno e progesterona na saliva. Foram avaliadas 39 mulheres com idade entre 19 e 47 anos, com ciclos menstruais regulares e sem morbidades associadas à dor. Todas as mulheres foram orientadas quanto aos propósitos desta pesquisa, e somente participaram do estudo aquelas que preencheram os critérios de inclusão e assinaram o termo de consentimento livre e esclarecido. A avaliação foi realizada em três momentos do ciclo menstrual: fase menstrual, fase folicular e fase lútea. Em cada uma dessas fases foram utilizados os seguintes métodos: coleta da saliva no início de cada sessão, para avaliação dos níveis hormonais; avaliação de fluxo salivar; avaliação sensitiva superficial (dor, tato - IITC Woodland Hills, EUA; frio, calor - MSA II e vibratórios - Somedic, Suécia) aplicada na região do ramo maxilar do nervo trigêmeo e na região do antebraço, ambas no lado direito da paciente; e avaliação das sensibilidades gustativa (doce - glicose, salgado - cloreto de sódio, azedo - ácido cítrico e amargo - ureia) e olfativa (isopropanol em diferentes concentrações). Foram observadas oscilações sensitivas em todas as modalidades de acordo com o momento do ciclo menstrual das mulheres avaliadas, sendo que níveis baixos de estrógeno se associaram a altos limiares de dor de profundidade no braço (p=0,008) e na face (p=0,041), altos limiares táteis (p=0,001) e álgicos superficiais (p=0,006) na face. Em contrapartida, altos níveis de progesterona se associaram a altos limiares de dor de profundidade na face (p=0,033) e altos limiares do sabor salgado (p < 0,001). Concluímos que o estrógeno e a progesterona estão envolvidos na neuromodulação da sensibilidade somestésica, gustativa e olfativa de mulheres, durante o ciclo menstrual
There is a sexual difference on pain perception that is supported by the scientific literature. Moreover, sexual hormones seem to be involved in the modulation of sensory detection and there is evidence of sensory variation during the menstrual cycle. Thus, the aim of this study was to investigate the somatosensory (thermal, painful, tactile, vibratory and electric), gustatory (salty, bitter, sweet, sour) and olfactory thresholds during the menstrual cycle in healthy women and verify association with saliva concentration of estradiol and progesterone. We evaluated 39 women aged between 19 and 47 years, with regular menstrual cycles and with no comorbidities related to pain.All women were instructed about the purposes of the study and only those that signed the informed consent were included. The evaluation wasperformed in three moments of the cycle: menstrual phase, follicular phase and luteal phase. In each of these stages, the following methods were used: saliva collection at the beginning of each session, to assess hormone levels; salivary flow measurement; somatosensory evaluation with quantitative sensory testing (pain, tactile - IITC Woodland Hills, USA; cold and warm - MSA II; and vibration - Somedic, Sweden) applied to the right maxillary branch region of the trigeminal nerve and right forearm region; and gustative (sweet - glucose, salt - sodium chloride, sour - citric acid and bitter - urea) and olfactory (isopropanol at different concentrations) thresholds. All sensory thresholds showed fluctuation during the menstrual cycle. Lower estrogen levels were correlated tohigher deep pain thresholds at the forearm (p=0.008) and face (p=0.041); they were also associated with higher tactile thresholds (p=0.001) and higher superficial pain (p=0.006) thresholds at face.High levels of progesterone were associated with high deep pain threshold at the face and high salty threshold (p < 0.001). In conclusion, estrogen and progesterone seems to be involved in sensory neuromodulation in women, during the menstrual cycle

Research on pain in individuals with intellectual disabilities has largely focused on identification of pain and medical management of pain symptoms. Pain management programmes have not routinely been offered to such individuals. In view of the ample evidence that Cognitive Behaviour Therapy (CBT) can be used for chronic pain management including the management of dysmenorrhea in the general population, and the preliminary evidence for its effectiveness in people with intellectual disability (McManus & McGuire, 2014), there is a rationale for evaluating a CBT-based pain management programme for menstrual pain in women with intellectual disabilities. The aim of this study was to develop and evaluate a theory-based cognitive behaviour therapy (CBT) programme for menstrual pain management in young women with intellectual disabilities. The programme was developed from the theory-based programme “Feeling Better” (McManus & McGuire, 2010). The study used a mixed methods design with the intervention delivered in group format, on a weekly basis, to those in the treatment condition. Those in the control condition received treatment as usual. Information was gathered throughout the process on a number of key pain variables including pain management knowledge, pain coping strategies, pain intensity and pain interference. Process evaluation was conducted with key stakeholders to examine which elements of the programme were most relevant in promoting change. Results suggest that participation in the menstrual pain management group had a positive impact in terms of increasing pain management knowledge over time, and increasing the use of wellness-focused coping strategies to manage pain in everyday situations. Findings suggest that a cognitive-behavioural therapy programme can be effectively used to support menstrual pain management amongst young women with intellectual disabilities.

O objetivo deste trabalho foi analisar a influência do ciclo menstrual nas alterações de limiar de dor à pressão (LDP) na musculatura mastigatória de mulheres com sinais e sintomas de Disfunção Temporomandibular (DTM). Inicialmente 47 voluntárias entre 18 e 40 anos participaram do estudo, das quais 36 foram incluídas no experimento: 15 com sinais e sintomas de DTM (7 sob terapia com contraceptivos orais (CO) e 8 sem CO) e 21 saudáveis, sem sinais e/ou sintomas de DTM (8 com CO e 13 sem CO). Os LDPs dos músculos masseter e temporais (anterior, médio e posterior), e do tendão de Aquiles foram medidos bilateralmente, por meio de um algômetro, durante 2 ciclos menstruais consecutivos, nas 4 diferentes fases: menstrual (dias 1-3), folicular (dias 5-9), periovulatória (dias 12-16) e lútea (dias 19-23). Em cada fase do ciclo, as voluntárias relataram sua dor em uma Escala de Análise Visual (EVA). Os resultados foram submetidos à análise de variância a 3 critérios para mensurações repetidas, a um nível de significância de 5%.Foram encontrados LDPs significativamente menores nos músculos temporal e masseter e no tendão de Aquiles das mulheres com DTM quando comparado às mulheres assintomáticas, independentemente da fase do ciclo e do uso de contraceptivos (p < 0,05). De uma maneira geral, os LDPs foram maiores em mulheres em terapia com contraceptivos orais, quando comparado às mulheres sem terapia. Parece não existir influência das diferentes fases do ciclo menstrual no LDP, independentemente da presença ou não de DTM.
The aim of this study was to investigate the influence of the menstrual cycle on the Pain Pressure Threshold (PPT) figures of the masticatory muscles in women with signs and symptoms of Temporomandibular Disorders (TMD). Forty-seven volunteers (ages between 18-40 years-old) were initially recruited for this purpose. According to the criteria adopted, 36 were included. The experimental group was composed of 15 women with myofascial pain (RDC/TMD) (7 under oral contraceptive medication), while 21 women with no TMD signs or symptoms (8 under oral contraceptive medication) composed the control group. The PPT values of masseter and temporalis (anterior, middle, and posterior regions) muscles, as well as the Achilles? tendon were bilaterally screened during two consecutive menstrual cycles, in the following phases: menstrual (day 1-3), follicular (day 5-9), periovulatory (day 12-16) and luteal (day 19-23). A visual analog scale (VAS) was used to address subjective pain in each menstrual phase. Data were submitted to 3-way ANOVA for repeated measurements, with a 5% significant level. The PPT values were significantly lower in the temporalis, masseter, and the Achilles? tendon of TMD patients when compared with the asymptomatic controls, regardless of the menstrual cycle phase or the use of oral contraceptives (p<.05). Overall, the PPT values were higher for patients under oral contraceptive therapy, while VAS was, in general higher at the menstrual phase (p<.05). It appears that the different phases of menstrual cycle have no influence on the PPT values, regardless of the presence of a previous condition, as myofascial pain.

Não há consenso na literatura quanto à utilização da laserterapia de baixa intensidade (LLLT) no tratamento da DTM dolorosa. O objetivo deste estudo foi analisar a efetividade da LLLT ativa e placebo na redução da dor, da ansiedade e do cortisol salivar de mulheres com dor miofascial em função das flutuações hormonais relacionadas ao ciclo menstrual. 124 mulheres, 94 diagnosticadas com dor miofascial (Research Diagnostic Criteria for Temporomandibular Disorders) foram divididas em: grupo laser (31), placebo (30), sem tratamento (33) e controle (30). A LLLT foi aplicada em pontos pré-estabelecidos da região orofacial, 2x/semana, oito sessões (780 nm, masseter e temporal anterior = 5 J/cm2, 20 mW, 10 segs. e região da ATM = 7,5 J/cm2, 30 mW, 10 segs.). A dor foi mensurada quanto à sua intensidade (Escala Visual Analógica), sensibilidade (limiar de dor à pressão em pontos orofaciais e corporais, LDP) e aspectos qualitativos/afetivos (Versão Reduzida do Questionánio de Dor de McGill, SF-MPQ). Além disso, foi dosado o cortisol salivar matutino a fim de se estabelecer os níveis de estresse, e aplicado o Inventário de Ansiedade de Beck para avaliar a ansiedade percebida. Foram também coletados dados relativos ao ciclo menstrual (data da última menstruação, uso de anticoncepcional, menopausa). Para as comparações intra-grupos ao longo da LLLT foram utilizados os Testes de Friedman e Kruskal-Wallis; para as comparações inter-grupos, o Mann-Whitney (p < 0,05). As mulheres com dor miofascial apresentaram LDP reduzido em relação às controles, não houve variação do LDP para nenhum grupo após a LLLT. Foi observada redução da intensidade de dor para os três grupos em comparação ao momento inicial (p < 0,05): Laser (80%), Placebo (85%) e Sem Tratamento (43%). Apenas no grupo Laser houve manutenção da redução da intensidade de dor de mulheres que não faziam uso de anticoncepcionais após 30 dias de finalização da LLLT (p < 0,001). O período pré-menstrual se mostrou crítico para todas as variáveris analisadas. Houve redução do escore total do SF-MPQ e da ansiedade para todos os grupos (p < 0,05). Os níveis de cortisol não diferiram entre mulheres com dor miofascial e controles, e também não variaram ao longo do tratamento. A LLLT ativa e placebo são capazes de reduzir variáveis subjetivas (intensidade de dor, índices do SF-MPQ e ansiedade), porém não alteram a sensibilidade à dor da região orofacial ou de pontos corporais, e o cortisol salivar. Ambas apresentam efetividade clínica similar em mulheres com dor miofascial durante o período de tratamento (sessões de laser), embora o laser ativo seja mais efetivo na manutenção dos resultados em mulheres em idade fértil sem o uso de anticoncepcionais (maior flutuação hormonal)
There is no consensus in the literature regarding the use of low-level laser therapy (LLLT) in the treatment of painful TMD. The aim of this study was to analyze the effectiveness of active and placebo LLLT in reducing pain, anxiety and salivary cortisol in women with myofascial pain based on the hormonal fluctuations related to the menstrual cycle. 124 women, 94 diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorders) were divided into: laser group (31), placebo (30), without treatment (33) and control (30). The LLLT was applied at pre-established points of the orofacial region, 2x/week, eight sessions (780 nm, masseter and anterior temporal = 5 J/cm2, 20 mW, 10 sec. and ATM region = 7.5 J/cm2, 30 mW, 10 sec.). The pain was measured in terms of intensity (Visual Analogue Scale), sensitivity (pressure pain threshold at orofacial and corporal points, PPT) and qualitative/affective aspects (Short-Form of the McGill Pain Questionnaire, SF-MPQ). In addition, the morning salivary cortisol was measured to establish the stress levels, and the Beck Anxiety Inventory was applied to evaluate the perceived anxiety. Data of the menstrual cycle were also collected (date of last menstruation, use of oral contraceptives, menopause). For intra-group comparisons over LLLT, the Friedman and Kruskal-Wallis tests were used; for intergroup comparisons, Mann-Whitney (p < 0.05). Women with myofascial pain showed reduced PPT when compared to controls, there was no change in PPT for any group after LLLT. Pain intensity reduction was observed for all groups compared to the baseline (p < 0.05): Laser (80%), Placebo (85%) and Without Treatment (43%). Only in the Laser group, pain intensity reduction was maintained in women who did not use oral contraceptives after 30 days of LLLT completion (p < 0.001). The pre-menstrual period was critical for all variables analyzed. There was a reduction in SF-MPQ total scores and anxiety for all groups (p < 0.05). Cortisol levels did not differ between women with myofascial pain and controls, besides they did not vary with the treatment. Active and placebo LLLT can reduce subjective variables (pain intensity, SF-MPQ indices and anxiety), but they do not change pain sensitivity at orofacial and corporal points, and salivary cortisol. Active and placebo LLLT shows similar clinical effectiveness in women with myofascial pain during the treatment period (laser sessions), although the active laser is more effective in maintaining the results in women of fertile age without oral contraceptives use (higher hormonal fluctuation)

Objetivos: Determinar la efectividad del Kinesiotape en la reducción del dolor debido a la dismenorrea en jóvenes-adultas. Métodos: Se realizó un estudio experimental, tipo ensayo clínico en mujeres de la Escuela de Policías de Chorrillos y San Bartolo en Lima, Perú. El muestreo se realizó por aleatorización por bloques, se distribuyeron las 229 participantes en bloques de 6. Se tuvo un total de 36 bloques y dentro de cada bloque se eligió al azar la asignación a los grupos de intervención o de Kinesiotape y control o de Kinesiotape simulado. Se aplicó el Kinesiotape por 4-5 días al grupo intervención y al de control. Se colocaron tres bandas adhesivas de 5 cm de ancho y 12 de largo, la banda horizontal se colocó de forma directa, la banda vertical se aplicó de caudal a cefálico en la zona suprapúbica, y la última banda se aplicó de forma horizontal en la zona lumbar, a la altura de L4. El dolor menstrual y lumbar se valoró con la Escala de calificación numérica del dolor antes, 2-3 hrs después de la aplicación del método, a las 24 hrs, 48 hrs y 72 hrs respectivamente. Finalmente, se realizó la fase de intervención con una duración de 3 meses por cada integrante en donde se midió el dolor menstrual y lumbar durante su periodo menstrual. Resultados: Se evaluó la eficacia del Kinesiotape versus el Kinesiotape simulado en el dolor asociado a la dismenorrea primaria. Las diferencias entre el grupo de control e intervención con respecto al dolor menstrual fueron que en el mes 1 luego de 2-3 horas de la aplicación del Kinesiotape el dolor se redujo en -2.32 (p<0.001), en el mes 2 de -2.8 (p<0.001) y en el mes 3 de -1.3 (p<0.001). Se observó que a las 24 horas del efecto, el dolor se redujo en -2.15 (p<0.001) en el mes 1, -1.77 (p<0.001) en el mes 2 y -0.87 (p<0.001) en el mes 3. Asimismo, en el dolor lumbar se observó el efecto del Kinesiotape a las 24 horas de la aplicación en el mes 1 con una diferencia de -0.5 (p: 0.013), en el mes 2 -0.62 (p: 0.001) entre ambos grupos. Conclusiones: La aplicación del Kinesiotape es efectiva para reducir el dolor abdominal relacionado a la dismenorrea en comparación a la aplicación del Kinesiotape simulado.
Objectives: Determine the effectiveness of Kinesiotape to decrease pain due to dysmenorrhea in young adult women. Methods: An experimental study was conducted a clinical trial in women of the Police school in Chorrillos and San Bartolo in Lima, Perú. We performed a blocked randomization. The 229 participants were distributed in blocks of 6 individuals. A total of 36 blocks were taken and within each block the allocation to the intervention group and control group was chosen at random simulated. Kinesiotape was applied for 4-5 days to the intervention and control group. Three adhesive bands 5 cm wide and 12 long were placed, the horizontal band was placed directly, the vertical band was applied from flow to cephalic in the suprapubic area, and the last band was applied horizontally in the area lumbar, at the height of L4. Lumbar and menstrual pain was assessed with the Numerical Pain Rating Scale before, 2-3 hours after the application of the method, at 24 hours, 48 hours and 72 hours respectively. Finally, the intervention phase was carried out with a duration of 3 months for each member where menstrual and lumbar pain was measured during their menstrual period. Results: The efficacy of Kinesiotape vs Sham Kinesiotape in pain associated with primary dysmenorrhea was evaluated. The differences in the results between the control and intervention group with respect to menstrual pain were that in month 1 during 2-3 hours of the application of Kinesiotape the difference was -2.32 (p <0.001), in month 2 of -2.8 (p <0.001) and in month 3 of -1.3 (p <0.001). It was observed that 24 hours after the effect of Kinesiotape on the control group had a difference of -2.15 (p <0.001) in month 1, -1.77 (p <0.001) in month 2 and -0.87 (p <0.001) in month 3. Also, in lumbar pain the effect of Kinesiotape was observed 24 hours after application in month 1 with a difference of -0.5 (p: 0.013), in month 2 -0.62 (p: 0.001) between both groups Conclusions: During the intervention period with the application of Kinesiotape to the intervention group, abdominal pain related to dysmenorrhea was reduced compared to the application of simulated Kinesiotape in the control group.
Tesis

碩士
國立交通大學
生醫工程研究所
101
Pain is a complex and subjective experience. Therefore, objective assessment of pain scale is essential to the understanding the mechanism of pain as well as the development of pain treatments. There were numerous studies focusing on the induced pain with short duration caused by external stimulus. However, pain is endogenous and lasting in most situations in daily lives. The purpose of this work is to develop an objective metrics for measuring endogenous pain scale by analyzing resting magnetoencephalographic (MEG) signal data. We concentrate on the pain caused by primary dysmenorrhea (PDM, menstrual pain without pelvic abnormality). The data were collected by Taipei Veterans General Hospital from 14 PDM patients at the menstrual phase. Three categories of features were extracted from the acquired MEG data. The first category was spectral analysis, including relative band powers, median frequency (MF), 90% spectral edge frequency (SEF90), and Shannon (SSE),Tsallis (TSE), and Rényi (RSE) spectral entropies. The second category was temporal complexity analysis, including Lempel-Ziv complexity (LZC) and multi-scale entropies (MSE). The third category of features was hemispheric asymmetric indices of the features in the first and second categories. The best feature, asymmetric index of MSE in temporal scale 77 in anterior medial parietal (amP) region, can be used to adequately predict the self-rating pain scale (simple regression analysis, p=0.0007). Then we combined other features by forward selection. In this step, we mainly incorporated the asymmetric indices of higher temporal scales in amP region. These features were used in the assessment model constructed by multiple linear regression. Through leave-one-out cross-validation, the proposed method achieved 0.2 residual error in predicting pain scale (real value from 0 to 10). After the pain scale value was quantized to integers, it can achieve 100% accuracy in pain assessment by using eight features. We expect that the proposed method could be a reliable indicator for the assessment of endogenous pain scale in clinical applications.

碩士
國立東華大學
諮商與臨床心理學系
105
This study found different dissertations from the social and cultural, biomedical, female physical experiences and the body space of disease. This study interviewed four women who suffering from menstrual pain and re-explained how menstrual pain presented in the life of women by using phenomenological psychological investigation. For women, menstrual pain is a space collapse and the absence of time. Women who suffering from menstrual pain are forced to focus only on their own body. They will take painkillers to help themselves to stay in the world when they feel uncomfortable and will take painkillers to comfort themselves for stay in the world at the mean time. Their relationships would not be disturbed. The interpersonal bonding of women with menstrual pain would be closeness instead of distance. The position of women with menstrual pain needs to be aware by themselves, because their conscious will change between two "I" (inside I and outside I). Because of the change of consciousness between two "I" (inside I and outside I ) which would confused women. The characteristics of menstrual pain, "sick but not sick”, let women becoming "normal abnormalities" in the medical treatment. The symptomatic control is a general intervention for menstrual pain in the medical conditions now days. And, women with menstrual pain should change the way to take care of themselves by different life style. When the women began to take care of menstrual pain, they will listen to the body and think more about their body. To offer a space for women suffering from pain taking some rest, will be helpful for them stay in the world. Women with menstrual pain could try to re- schedule the time and space, and they can as well as create a new life style. At last, corresponded to the literature, this study aimed to discuss social and cultural ethics, embarrassing situation in medical conditions, physical time and space, gender and interpersonal relations.

博士
高雄醫學大學
護理學研究所
102
The purpose of this study is to discuss the effects of acupressure on menstrual distress, low back pain, and self-care behavior in dysmenorrhic young female adults. We recorded cases of menstrual lower back pain among female students from a university in the southern area; among these students, those who scored over 4 in the single Visual Analog Scale for Pain (VASP) were enrolled. The students were randomly assigned into the acupressure and control groups; the control group was only provided with health-education handbooks without acupressure intervention, while the experimental group received received acupressure massage three times a week for 30 minutes. Data were collected 5 times at the following intervals: before admission, 30 min after acupressure administration, after 4, 8, and 12 months to track variations in their menstrual lower back pains. In all, we studied 130 cases (65 in the control group and 65 in the experimental group). The scales used to collect data were: Basic personal attributes questionnaire, Visual Analog Scale for Pain (VASP), Short Form McGill Pain Questionnaire (MPQ-SF), Menstrual Distress Questionaire (MDQ), and Dysmenorrhic Self-Care Behavior Scale (DSCBS). The collected data were statistically analyzed using the SPSS17.0 Windows suite software. Statistical methods included percentage, mean, standard deviation, chi-square test, repeated measures analysis of variance, etc. Studies on data collected 30 min after and 4, 8, and 12 months after acupressure administration indicate that the experimental group, experienced significantly lesser menstrual distress and lower back pain than the control group; moreover, the experimental group was also capable of increased dysmenorrhic self-care behavior. These results may provide references to healthcare professionals and young women to administer self-care during menstrual distress and low back pain , and to help further understand the practical effects of acupressure on acupoints for treating menstrual distress.

碩士
高雄醫學大學
性別研究所碩士班
94
The title of the dissertation is ‘When “experts” meet experts’. It means women who suffered menstrual pain hold embodied knowledge became experts and encounter the western medical professionals. The two kinds of experts carry on a dialogue involving “power/knowledge” relationship. In the past, Taiwanese feminist researches focused their criticism most on medicalization, or adopted action research and experience sharing in groups to wake up women’s consciousness and tried to rebuild the positive image of menstruation. There is very little discussion about the experience of women who would use the medical resources and in need of medical care. By applying qualitative research methods, I have interviewed fourteen women with painful menstrual experience and two medical professionals. We find that the embodiment knowledge of menstrual pain is very complicated and varied. These women are able to judge the applicability of the medical treatments given by the medical professionals and demonstrate their autonomy by relying on their rich embodied knowledge. Second, during the interactions between women experts and western medical professionals, we can see how those women practice their subjectivity and agency clearly. When they decided to seek doctor’s help, and chose clinics and doctors according to their different needs. During the meeting with the medical professionals, they do not blindly follow doctor’s instructions. Instead they use their rich embodied knowledge to examine medical knowledge, and adopt various methods to maximum medical treatments to their specific conditions. In the process, Western medicine is no more the dominant but the assistant one. Examining the experiences of these women not only gives us an insight to the problems of over medicalization, but also offers various ways to the women how to recapture the autonomy and how to use medical resources with flexibility. Besides, the research on women’s embodied knowledge further approves the status of women being the experts of her own menstrual pain; it corresponds feminist epistemology. More important, the research aims to draw the attention of the medical science to women’s needs and expecting a different kind of research developing in the near future. Moreover, the research expects to empower women suffered menstrual pain, so that they could use the medical resources to their own benefit.

碩士
國立交通大學
資訊科學與工程研究所
103
Objective assessment of pain intensity is essential to investigate the mechanism and treatment of pain. However, pain is a subjective and complicated experience. It is challenging to quantify the intensity of perceived pain objectively and accurately. Most of the pain-related studies concentrate on pain induced by external stimulation but not on endogenous pain. In this work, we develop a method to objectively assess the subjective intensity of endogenous pain by analyzing the resting state magnetoencephalographic (MEG) recordings. The MEG data acquired at Taipei Veterans General Hospital for 25 primary dysmenorrhea patients during their menstrual phase were used to evaluate the accuracy of the proposed method. We estimated the cortical source activity from resting MEG recordings by using maximum contrast beamformer and extracted spectral and temporal features from the cortical source activity. Spectral features include relative band power, spectral entropy, median frequency, and spectral edge frequency. Temporal features include multiscale sample entropies (SampEn) and Lempel-Ziv complexity. The hemispheric asymmetric indices of features mentioned above were also calculated as a type of feature. After feature extraction, we applied the sequential forward search and multiple linear regression to construct the pain assessment models. According to leave-one-out cross-validation the correlation coefficient between the predicted pain scores using the pain assessment model and self-rating pain scores was 0.62 (p=0.00097), and the mean residual error was 1.39. The reliability of the proposed pain assessment model was significant in a random permutation test (p=0.026). We also examined the features frequently selected. We found that about 80% of assessment models contained both the SampEn in temporal scale 95 in the left precuneus and the asymmetric index of the SampEn in temporal scale 53 in the medial part of superior frontal gyrus. Both precuneus and superior frontal gyrus have been reported to be associated with pain-related activation in previous studies. The proposed pain assessment model could be used as a reliable indicator for the assessment of endogenous pain intensity in clinical applications.

博士
國立陽明大學
生物醫學資訊研究所
106
Chronic pain poses severe clinical and health problems, leading to increased burdens on medical and financial costs worldwide. Mood and anxiety disorders have been reported to associate with chronic pain. Primary dysmenorrhea (PDM), cyclic menstrual pain in the absence of pelvic anomalies, is one of the most common gynecological disorders in reproductive females. Classified as chronic pelvic pain syndrome, PDM encompasses recurrent and spontaneous painful (“on”) and pain-free (“off”) states, which is thus a good clinical model to study state and trait effects of chronic pain on the brain. Magnetoencephalography (MEG), as a noninvasive neurophysiological measurement with superior temporal resolution (approximately 1 ms) and good spatial resolution (approximately 2~3 mm), possesses high sensitivity in capturing changes of neural activities across multiple temporal scales. In this dissertation, by using MEG, we investigated the effects of long-term menstrual pain on central processing of early emotion perception (first study) and brain complexity across varying temporal scales (second study). We further delineated the intersubject differences in genetic variations on brain complexity in PDM (third study) to understand the contributions of phenotype, endophenotype, and genotype in PDM. Neuroimaging studies have found brain structural and functional alterations in PDM females (PDMs), suggesting that PDMs develop functional reorganization with a network shift from the affective processing of salience to the cognitive modulation of pain. However, the effect of long-term menstrual pain on early central processing of emotion remains elusive. In the first study of this dissertation, we aimed to investigate whether central processing of early emotion perception is modulated by long-term menstrual pain, both in the presence (painful) and absence (pain-free) states of the menstrual cycle in PDM, to delineate the state-related and trait-related functional changes in the brain. Seventy-two right-handed PDMs and seventy-six age-matched otherwise healthy women (CONs) during menstruation phase (MENS) and periovulatory phase (POV) were recruited. Psychological inventories and pain experience were collected. Emotional perceptual event-related responses to neutral, happy, sad, and angry voice stimuli were collected by magnetoencephalography (MEG) device. Source analysis using the beamforming method within theta activity (4-8 Hz) was performed for estimating cortical responses at 80-150 ms after stimulus onset (perceptual proessing stage), where theta activity is reported to play an important role in emotional voice perception. Brain emotional response indexes (BERIs) were calculated as the percentage change of theta activity to each emotional voice to that of neutral voices. Higher BERIs were found in the limbic regions to sad voices in PDMs compared to those in CONs, which might be caused by the imbalance of gating mechanism in limbic systems for negative emotion information shaped by recurrent chronic pain. On the other hand, PDMs might have lower subjectively experienced emotional involvement to negative emotion comparing to CONs, as seen in PDMs’ lower BERIs in emotional voice areas to angry voices. Decreased BERIs in the prefrontal cortex and anterior cingulate cortex to sad voices in PDMs were also found during pain-free state, which might be associated with poor emotion resilience/regulation to negative emotion caused by long-term menstrual pain, showing that altered emotional perceptual processing in PDMs might be selective to negative emotions. The findings of the first study suggest that personal experience with long-term menstrual pain might shape the function and connectivity within brain regions in central processing of emotional perception and could eventually impact women’s long-term health. It is important to bear in mind that the brain encompasses both regular and irregular neuronal interactions. The former is often regarded as linear, predictable, synchronous, or oscillatory and the latter is regarded as nonlinear, unpredictable, asynchronous, or nonoscillatory. The irregularity and unpredictability (uncertainty) of neurophysiologic output signals across varying temporal scales can be regarded as neural complexity, which is related to the adaptability of the nervous system, brain functions, and the information processing between neurons. However, up-to-now, neural activities in the brain are typically analyzed using linear approximations. Also, there remains a paucity of evidence on the spontaneous neural complexity at rest in chronic pain, particularly the chronic recurrent menstrual pain. Brain complexity, estimated by entropy-based methods origin from information theory, is essential for revealing underlying nonlinear and irregular neurophysiological mechanism of chronic pain. In the second and the third studies of this dissertation, brain complexity features with multiple time scales and spectral features were extracted from resting-state magnetoencephalographic signals of 156 female participants with/without PDM during pain-free state. In the second study, revealed by multiscale sample entropy (MSE), PDMs exhibited loss of brain complexity in regions associated with sensory, affective, and cognitive components of pain, including sensorimotor, limbic, and salience networks. Significant correlations between MSE values and psychological states (depression and anxiety) were found in PDMs, implicating their altered neuroplasticity. The second study suggests that MSE is an important measure of brain complexity and is potentially applicable to future diagnosis of chronic pain. Intersubject differences of susceptibility to PDM might, at least partly, be accounted by genetic variations. Recent studies showed that genetic polymorphism is a critical factor that shapes brain functions by chronic pain experience. In the third study, we further examined the effect of genetic polymorphism of brain-derived neurotrophic factor (BDNF), a widely studied pain- and emotion-related gene, on brain complexity in PDMs and CONs. In healthy controls, when compared with wild-type group (Val/Val genotype), the variant groups (Val/Met and Met/Met genotypes) demonstrated lower brain complexity in extensive brain regions, suggesting a possible protective role of Val/Val homozygosity on brain complexity in healthy females. In contrast, in PDM females, between-genotype differences in brain complexity seen in CONs were largely diminished, suggesting a “stuck in a rut” phenomenon and the interaction effects of long-term menstrual pain experience and BDNF Val66Met polymorphism on brain complexity. Brain complexity in the emotional circuits and pain transmission regions was altered by and correlated to long-term menstrual pain experience or depressive/anxiety levels dependent on the specific type of BDNF polymorphism. Together, these findings might add to current knowledge of neuroplasticity changes caused by the gene-pain interaction and might aid the advances of application of neuroinformatics on chronic recurrent pain.

碩士
國立陽明大學
腦科學研究所
107
Primary Dysmenorrhea (PDM), defined as menstrual pain without discernable organic causes, is inexorably common in reproductive women, about 40-90% of women may suffer from it. About 20% of PDM have extreme pain intensity, they can be severe in the context of being refractory to medication, daily function impairment. The novel therapeutic method is needed for pain alleviation for this particular phenotype. Transcranial Direct Current Stimulation (tDCS) on the motor cortex is a non-invasive neuromodulation technology for pain modulation. We have also previously reported that PDM females may engage motor-cortex based descending pain modulation system in our resting-fMRI and thermal pain-activation fMRI studies. In the current study, we demonstrated the analgesic efficacy of tDCS on severe PDM, and the associated functional connectivity changes. Thirty one right-handed severe PDM patients (20-35 years old) were eventually enrolled. They were randomly assigned, in a double-blind way, to either real tDCS group or sham tDCS group. Visual Analogue Scale (VAS) was used to access the menstrual pain rating. Resting-state functional MRI images were acquired and periaqueductal grey (PAG)-seeded functional connectivity (FC) analyses were using to elucidate the dynamic brain neuroplasticity of pain matrix after tDCS intervention. In the real group, both immediate and long-term tDCS analgesic effects were evidenced with significant reduction of spontaneous pain. The FC between PAG and anterior cingulate cortex (ACC) decreased immediately after tDCS procedure in real tDCS group but increased in sham tDCS group. The right PAG-bilateral ACC FCs was attenuated in the real group as compared to the sham group. The PAG-insula FC was decreased, and the change in FC between PAG and amygdala was positively correlated with the change in clinical pain intensity one month after tDCS procedure in real tDCS group. The aforesaid brain regions take an important role in descending pain modulatory system (DPMS). We suggest that tDCS on the motor cortex modulate the pain anticipatory copying of the brain. In conclusion, we report that tDCS has both immediate and long-term analgesic efficacy alleviating clinical menstrual pain by means of modulating the DPMS. To our knowledge, this is the first study in the literature investigating the tDCS efficacy for severe PDM. Our work implicates that the tDCS can be a potential novel treatment for severe PDM.

Primary dysmenorrhoea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynaecological condition that affects between 45 to 95% of menstruating women. Despite the high prevalence, dysmenorrhoea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle. The overall purpose of this thesis is two-fold: first, to contribute knowledge about the impact and consequences of recurrent severe menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhoea, and secondly, to investigate day-time and night-time treatment of recurrent primary dysmenorrhoeic pain. For this thesis, I completed five separate studies on three different groups of young, otherwise healthy women with a history of severe primary dysmenorrhoea, and age-matched controls without dysmenorrhoea. The first two studies, presented in Chapter 2, addressed the question of whether women with primary dysmenorrhoea are hypersensitive to experimental pain. I used clinically-relevant experimentally-induced muscle pain stimuli (intramuscular injection of hypertonic saline and ischaemia) in referred and non-referred sites of menstrual pain, at different phases of the menstrual cycle. Women with dysmenorrhoea, compared to women without dysmenorrhoea, had increased sensitivity to deep-muscle pain both within the area of referred menstrual pain and at a remote pain-free site. Further, the increased muscle pain sensitivity was evident even in phases of the menstrual cycle when women did not have menstrual pain, illustrating that the changes in pain perception extend outside of the painful menstruation phase. These findings suggest that women with dysmenorrhoea show long-lasting changes in pain processing possibly because of the recurrent dysmenorrhoeic pain. A secondary aim of the study presented in Chapter 2a, was to determine the impact of menstrual cycle phase on experimentally-induced muscle pain sensitivity in women with and without primary dysmenorrhoea. My results suggest that menstrual cycle phase has no effect on pain sensitivity in either group of women. As part of my studies, I investigated the impact of dysmenorrhoeic pain on quality of life and mood. I found that women with dysmenorrhoea had a significantly reduced quality of life (Chapter 3) and poorer mood (Chapter 2a and Chapter 5), during menstruation compared to their pain-free follicular phase, and compared to the menstruation phase of the pain-free control women. These data highlight the negative impact that primary dysmenorrhoea has on young women, for up to a few days every month. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed as the first-line therapy for menstrual pain. Yet, severe dysmenorrhoeic pain is often poorly managed, especially at night, when the pain likely disrupts sleep. I conducted two studies investigating the effectiveness of diclofenac potassium, a readily-available NSAID with a low side-effect profile, compared to placebo, in alleviating severe primary dysmenorrhoeic pain across the day (Chapter 4), and during the night (Chapter 5). I also investigated the effectiveness of diclofenac potassium in improving subjective and objective sleep quality (Chapter 5). I found that the daily recommended dose (150 mg) of diclofenac potassium, administered at three timepoints across the first 24 hours of menstruation, significantly reduced perceived menstrual pain, compared to placebo. I confirmed that dysmenorrhoeic pain reduces polysomnographic and subjective measures of sleep quality compared with the pain-free follicular phase. I also showed, for the first time, that diclofenac potassium is effective, compared to placebo, in alleviating nocturnal pain, along with restoring subjective sleep quality and polysomnographic measures of objective sleep quality in women with severe primary dysmenorrhoea. My studies have addressed several gaps in the knowledge about primary dysmenorrhoea. I have shown that women with primary dysmenorrhoea are hypersensitive to deep muscle pain, supporting the hypothesis of other researchers that the recurrent menstrual pain experienced by these women is associated with central sensitisation, and may predispose women with primary dysmenorrhoea to other chronic painful conditions. Therefore, limiting the monthly noxious input into the central nervous systems of these women, by means of effective treatment of dysmenorrhoea, may improve their long-term health. The research presented in this thesis further highlights the efficacy of diclofenac potassium in relieving not only day-time and night-time dysmenorrhoeic pain, but also in restoring objective and subjective pain-induced sleep disturbances in women with dysmenorrhoea. Further, my research has shown that dysmenorrhoeic pain has an immediate negative impact on quality of life and mood during menstruation. The results of this thesis show the multi-factorial impact of dysmenorrhoea and should stimulate further research about the long-term benefits of effective treatment of menstrual pain.

The aim of this study is to study whether the pain associated with primary dysmenorrhea as well as the amount of medication used can be reduced via the application of osteopathic techniques including muscle energy technique, high velocity low amplitude technique and visceral manipulation. Twenty (N=20) female participants aged between 18 and 25 were recruited into the study via notices displayed around the Victoria University teaching clinic. Participants were randomly allocated to either an experimental group or control group. Baseline menstrual pain scores were obtained from both groups using the Mankoski pain scale. The control group rated their pain for three cycles without receiving any treatment. The experimental group received one treatment per cycle for three cycles between days 8-10 of their menstrual cycle. Tha Mankoski pain scale was used to rate the pain experienced each cycle. Medication diaries were kept by both groups. Within the limitations of the study, the results support the hypothesis that osteopathic treatment can decrease the pain associated with primary dysmenorrhea as well as the amount of medication taken. The results of this study present valuable outcomes for women with primary dysmenorrhea and osteopaths wishing to provide relief to such patients. However, further research is needed to establish whether or not the benefits are lasting. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.

碩士
嘉南藥理科技大學
藥物科技研究所
99
The issues of menstrual period （MP） of female last for 30~40 years from menarche to menopause, about half of a female’s life cycle. Dysmenorrhea is a common problems of menstrual period, with abdominal pain as a major symptom. Statistics show that about 20~90% women have experienced dysmenorrhea. For long, many females suffer from discomfort during their MP, which deeply influence their everyday life. Due to the lack of propaganda in the medication usage, many females do not have the right self-medication and self-care, and could not find a way to relieve their dysmenorrheal. If females have the correct knowledge, attitude and use the medicine right, they can not only relieve dysmenorrheal effectively, but also promote medicine safety. The purposes of this study was to investigate the prevalence of dysmenorrhea and understand the knowledge, attitude and behavior of medication usage for MP of female students of an university in southern Taiwan. In this study, we investigate the issues of dysmenorrheal by performing a questionnaire survey of 529 female students, from three departments in an university in southern Taiwan. SPSS/12.0 statistical software was applied. We used descriptive and inferential statistics procedure to collect and analyze the survey results. The results showed a high prevalence of dysmenorrhea as 74.7%. The rate of self-care during menstral by female students using medicines to release pain was 38.5%. In most cases, the knowledge of self-care of MP came from female’s mother. Most females would purchase pain relieving medicine from the pharmacy by themselves. In addition, whether or not the female students have taken Chinese or Western medicine courses do have a significant influence on their knowledge, behavior and attitude of using medicines in MP. From the results of this study, we suggest that the doctors, nurses and pharmacist should enhance the education on safety and the correct usage of medicine when they take care of the problems of MP for female students. Keywords: questionnaire, menstrual pain, knowledge, attitude, behavior, medication usage.