Laura C Seidman’s research while affiliated with McLean Hospital and other places

Menstrual pain is associated with deficits in central pain processing, yet neuroimaging studies to date have all been limited by focusing on group comparisons of adult women with vs without menstrual pain. This study aimed to investigate the role of the triple network model (TNM) of brain networks in adolescent girls with varied menstrual pain severity ratings. One hundred participants (ages 13-19 years) completed a 6-min resting state functional magnetic resonance imaging (fMRI) scan and rated menstrual pain severity, menstrual pain interference, and cumulative menstrual pain exposure. Imaging analyses included age and gynecological age (years since menarche) as covariates. Menstrual pain severity was positively associated with functional connectivity between the cingulo-opercular salience network (cSN) and the sensory processing regions, limbic regions, and insula, and was also positively associated with connectivity between the left central executive network (CEN) and posterior regions. Menstrual pain interference was positively associated with connectivity between the cSN and widespread brain areas. In addition, menstrual pain interference was positively associated with connectivity within the left CEN, whereas connectivity both within the right CEN and between the right CEN and cortical areas outside the network (including the insula) were negatively associated with menstrual pain interference. Cumulative menstrual pain exposure shared a strong negative association with connectivity between the default mode network and other widespread regions associated with large-scale brain networks. These findings support a key role for the involvement of TNM brain networks in menstrual pain characteristics and suggest that alterations in pain processing exist in adolescents with varying levels of menstrual pain.

A recent group cognitive behavioral therapy (gCBT) intervention for dysmenorrhea conducted by our team demonstrated feasibility, acceptability, and preliminary efficacy at reducing menstrual pain. This study aimed to use qualitative analyses to explore participants’ reflections about the intervention’s group dynamic. Participants included 20 young women ages 18–24 years with average menstrual pain of 8.0 (SD = 1.1) on a 0–10 (0 = none, 10 = worst pain possible) numeric rating scale. Semi-structured individual and group interviews were conducted after the intervention. Researchers then conducted deductive, iterative thematic analysis using a template analysis approach. Two themes were generated: benefit and logistics. The benefit theme included two sub-themes: (1) camaraderie (an emotional, psychological, or social connection between participants); and (2) sharing (information, advice, or experiences). The logistics theme highlighted how the structure of the group influenced the dynamic and was divided into two sub-themes according to the time frame being described: (1) reactions (participants’ experiences with how the group dynamic was facilitated); and (2) future (how the group structure could be improved). Results of this study contribute to the growing body of literature related to gCBT for pain conditions. Future research is needed to optimize the group dynamic and evaluate its specific therapeutic role in the treatment.

Objective: The present study sought to develop and perform the initial validation of a scale assessing sensitivity to menstrual pain and symptoms. Methods: Data were taken from a larger parent study in which participants were recruited from a nationwide sample of individuals via the UniVox platform (www.univoxcommunity.com). In that study, participants were stratified by age and self-reported menstrual pain. Participants in the parent study completed two online surveys, one at baseline and one at a 3-month follow up. Participants who provided complete responses to the potential scale items, as well as a variety of validated questionnaires, were included in the present analyses. Final item selection was determined by factor analyses, and measures of validity and reliability were examined. Results: Factor analyses support an 8-item scale assessing menstrual sensitivity. This scale, the Menstrual Sensitivity Index, demonstrates excellent internal consistency, good item-total correlations, and good total score test-retest reliability. Convergent validity emerged for menstrual- and pain-specific measures, and divergent validity emerged for anxiety sensitivity, anxiety, depression, non-menstrual bodily pain, and premenstrual symptoms. Conclusions: Menstrual sensitivity is a unique construct that reflects women's attunement to and fear of menstrual symptoms, and the Menstrual Sensitivity Index is a valid and reliable measure of this construct. This scale may be useful in advancing research and clinical work targeting menstrual pain.

The COVID-19 pandemic resulted in heightened stress for many individuals, with women reporting more stress than men. Although a large body of evidence has demonstrated that stress, in general, can impact the menstrual cycle, it is not yet clear if COVID-specific stress would impact women’s menstrual health. The current study explored the relationship between COVID-related stress and distress and menstrual variables (menstrual pain, number and severity of menstrual symptoms, and menstrual pain interference) in a sample of reproductive-age adult women. Seven-hundred fifteen women completed the initial survey and were re-contacted to complete the same survey three months later. Of those recontacted, 223 completed the follow-up survey. Results indicated that COVID-related stress and distress was associated with higher levels of menstrual pain, more frequent and more severe menstrual symptoms, and greater menstrual pain interference, even after accounting for age, hormonal use, bodily pain, and pain catastrophizing. Our findings suggest that women experience unique vulnerabilities that directly impact their health and functioning, and both research and clinical care should address these symptoms through careful assessment and treatment of menstrual pain and symptoms, particularly during and after periods of high stress and distress.

A substantial body of evidence exists demonstrating central pain mechanisms involved in the experience of menstrual pain. Yet, the neurobiological underpinnings are not yet known and have not yet been studied in adolescents. Further, no study has investigated the relationship of menstrual pain to non-physical pain (i.e., noxious visual stimuli) and examined brain connectivity in networks commonly associated with pain. Forty-six adolescent girls (ages 14 to 18) completed a 6-min resting state MRI scan and then completed a visual sensitivity task involving viewing a blue and yellow checkerboard stimulus. Visual unpleasantness ratings and self-reported average menstrual pain ratings were collected. Thirty-five resting-state networks was estimated using a multivariate data-driven method for group Independent Component Analysis (GICA). Cingulo-opercular (CN), prefrontal salience (pfSN) and default mode (DMN) networks were selected as a priori, as they are often associated with pain. Using dual regression approach, we extracted subject-specific network maps corresponding to each a priori network. Statistical models were analyzed using Randomise in FSL to investigate the association of menstrual pain and visual sensitivity scores with the connectivity of these networks. Menstrual pain was negatively associated with connectivity of wide-spread prefrontal areas within the DMN, thalamus, insula, and striatum. In contrast, visual sensitivity was positively associated with connectivity of the medial temporal subnetwork of the DMN. These data suggest that different pain experiences may result from unique neural mechanisms. For visual sensitivity, increased connectivity of medial temporal lobe DMN regions with anterior DMN may be a mechanism in which affective experience of noxious stimuli is linked with self-reported pain. For menstrual pain, dysregulated connectivity within the DMN and between the DMN and pain-related regions might lead to impaired regulation of other pain constructs and put some individuals at risk for chronic pain. Grant support from NIH/NICHD R01 HD093680.

The aim of this study was to understand the relationship between psychosocial factors, including mental health, pain cognitions and social support associated with menstrual pain severity in women with dysmenorrhea of no identified medical cause (primary dysmenorrhea; PD) and dysmenorrhea related to endometriosis. Participants included 1192 women aged 18-50 years with menstrual pain, recruited to an online cross-sectional survey in 2019. Questionnaires assessed self-reported menstrual pain severity, depression, anxiety, stress, pain catastrophizing, and social support. Women with endometriosis had significantly higher menstrual pain severity (p < 0.001) and pain catastrophizing (p < 0.001) than women with PD. Of the psychosocial factors, only pain catastrophizing (specifically, the helplessness sub-scale) predicted menstrual pain severity in each group. Overall, 36% of women with PD and 58% with endometriosis had clinically relevant levels of pain catastrophizing. Findings suggest a common psychological mechanism in women with menstrual pain, regardless of etiology. Interventions to reduce pain helplessness may be beneficial in supporting women with dysmenorrhea.

The Anxiety Sensitivity Index is a widely-used measure to assess anxiety sensitivity (i.e., the fear of anxiety and its associated symptoms). More recently, researchers have developed disease-specific measures assessing sensitivity to specific symptoms. To assess sensitivity to menstrual symptoms, we developed and evaluated the reliability and initial validity of the Menstrual Sensitivity Index (MSI), a modification of the Visceral Sensitivity Index. The MSI consists of 10 items rated on a 6-point Likert scale from 1 (“strongly agree”) to 6 (“strongly disagree”). Items assess respondents’ menstrual symptom-specific anxiety (e.g., fear and anxiety induced by menstrual pain, the thought that menstrual pain is a sign of other problems, etc.). Items are reverse scored and re-coded on a 0 to 5 scale. Total scores are calculated by summing all item responses; higher scores indicate more severe menstrual-specific anxiety. Participants included 1,160 women ages 18-55 years (mean=34.6, SD=9.5) who completed an online survey. Average menstrual pain was rated on a 0 (no pain) to 10 (worst pain possible) Numeric Rating Scale; enrollment was stratified such that 14.8% of participants rated their menstrual pain as 0-2, 59.7% rated 3-7, and 25.4% rated 8-10. All participants had self-reported regular menstrual cycles over the previous 12 months. Internal consistency was calculated using Cronbach's alpha, and initial validity was assessed using Pearson bivariate correlations. The MSI demonstrated excellent internal consistency (alpha=0.942). Scores were positively correlated with measures of average menstrual pain, menstrual symptoms, non-menstrual bodily pain, anxiety sensitivity, and pain catastrophizing (R's from 0.39-0.65; all p's<.001). Results indicate that the MSI demonstrates convergent validity with measures of similar constructs. The moderate strengths of the correlations also indicate some divergence, meaning that the MSI may assess a distinct construct relative to the other measures. Future research is needed to assess the test-retest reliability, factor structure, and other psychometrics. NIH/NICHD grant R01HD093680.

Purpose: The aims of the current study were to better understand, from the perspective of adolescents and young adults (AYAs) with sarcoma, parents, and providers, the friendship support needs of AYAs with bone and soft tissue sarcoma and the role of social media in facilitating social support for AYAs with sarcoma. Methods: Semistructured interviews were conducted with 21 participants. AYA (n = 10) ranged in age from 14 to 23 years (mean 19.3, standard deviation 3.4 years; 50% female). All AYAs reported a current or past diagnosis of sarcoma, except for one patient who had another cancer diagnosis but was receiving treatment through the sarcoma clinic. Five parents of the adolescent participants were interviewed, as well as six health care providers. Data analysis was conducted using theory-driven immersion/crystallization, incorporating the Resilience in Illness Model as a framework to guide interpretation of the data. Results: Four main themes associated with social support from friends and social media were identified: (1) Social media provides a way to feel normal and connected to friends; (2) Social media accentuates the frustration of being left behind; (3) Social media facilitates the need to be understood by peers who have experienced sarcoma, and (4) Social media can lead to despair, and also provide hope for the future. Conclusions: Connecting with peers through social media can play an important role in providing support for AYAs with sarcoma, but it may also amplify feelings of frustration and anxiety. Future work is needed to determine intervention components that can maximize the benefits of social media for social support of AYAs with sarcoma. Clinical Trial Registration number: NCT03130751.

Purpose Primary dysmenorrhea (PD; menstrual pain without an identified organic cause) has been proposed as a possible risk factor for the development of chronic pelvic pain, but the mechanism through which this process occurs is unknown. One possible mechanism is central sensitization – alterations in the central nervous system that increase responsiveness to pain leading to hypersensitivity. Repeated episodes of pain, such as those experienced over time with PD, may alter how the brain processes pain. Ecological momentary assessment (EMA; collection of data in real time in participants’ natural environments) is a novel data collection method that may help elucidate pain occurring during non-menstrual cycle phases. Patients and Methods The current observational study assessed the feasibility and acceptability of using EMA via text messages to collect pelvic pain data during menstrual and non-menstrual cycle phases in a community sample of adolescents and young adults (AYA) aged 16–24 years with and without PD and explored occurrence rates and intensity of non-menstrual pelvic pain (NMPP) in each of these groups. Results Thirty-nine AYA with PD and 53 healthy controls reported pelvic pain level via nightly text message. Global response rate was 98.5%, and all participants reported that the EMA protocol was acceptable. AYA with PD reported higher intensity (2.0 vs 1.6 on 0–10 numeric rating scale; p=0.003) and frequency (8.7% vs 3.1% of days; p=0.004) of NMPP compared to healthy controls. Conclusion The EMA protocol was feasible and acceptable. Though both the intensity and frequency of NMPP were low and at levels that would not typically warrant clinical assessment or intervention, these repeated nociceptive events may represent a potential mechanism contributing to the transition from cyclical to chronic pelvic pain in some individuals.