Systematic Reviews to Inform Practice, July/August 2026.
Authors: McManis BG, Harris NR, Howe‐Heyman A
Journal: Journal of Midwifery & Women's Health
mental health
psychology
open access
Abstract
Multi-site pain (i.e., the number of painful body locations a person
experiences, also known as pain widespreadness) is associated with central
sensitization, which is
defined as sensory amplification and impaired pain inhibition due to alterations in
the central nervous system. Research has shown that multi-site
pain in adolescence is a risk factor for the development of chronic pain in
adulthood, and that
dysmenorrhea (pain during menstruation) is a risk factor for persistent/chronic
pain. Cross-sectional studies consistently show higher levels of menstrual pain
intensity in individuals with chronic or persistent pain as compared to pain-free
controls, with a few
studies demonstrating dysmenorrhea as a precursor to chronic pelvic pain. Recent work has also shown higher levels of menstrual pain
intensity in adolescents with multi-site body pain. Therefore, it is critical to identify
potentially vulnerable individuals during adolescence, the time when dysmenorrhea
usually begins, in order to
provide effective treatments which may lessen the experience of widespread pain
during menstruation. Despite the likely contributions of both general pain widespreadness and
menstrual pain intensity to the development of future pain problems, less is known
about the extent of multi-site pain specifically during menstruation. Studies
investigating the link between dysmenorrhea and current or future pain problems have
been limited by only including measures of menstrual pain intensity, not the extent
of multi-site pain, in their analyses. Dysmenorrhea is often attributed to the lower
abdomen and pelvic regions as a result of physiological processes occurring in the
uterus. Many definitions of dysmenorrhea refer specifically to pain in the abdomen
and pelvis that may radiate to the back or thighs, likely due to the emphasis on the importance
of uterine contractions and prostaglandins in the process of menstruation. However, research has demonstrated
that pain occurs in other body regions during menstruation as well. Cordeiro
Rodrigues and colleagues used body maps to assess location of pain during
menstruation in young adult women with primary dysmenorrhea (mean age = 24.1, SD =
3.0) and found that most participants reported pain during menstruation in body
regions outside of the pelvis and lower abdomen. An expanded
understanding of pain occurring during menstruation, as opposed to the current use
of the term “menstrual pain,” may be needed in order to better
describe the lived experience of those with dysmenorrhea, which can then inform
future research and treatment approaches. Several studies in adolescents have included the assessment of pain location
during menstruation within the context of assessing menstrual cycle characteristics
and symptoms more generally. In one
population-based cohort study of 1,051 girls, headaches and lower back pain during
menstruation were reported by 64% and 58% of the sample, respectively. However, these studies typically
assess pain in a single item that includes other symptoms, making it impossible to
separate reports of pain, or with questionnaire items having a limited set of
pre-specified pain locations, which does not allow the respondent to report pain in
any except the listed locations. These methodologies do not fully address the
dimensionality of pain experienced during menstruation. No known research has used a
body map with adolescents to assess the location of pain during menstruation or
measured the extent of multi-site pain numerically based on the number of body
regions affected.
experiences, also known as pain widespreadness) is associated with central
sensitization, which is
defined as sensory amplification and impaired pain inhibition due to alterations in
the central nervous system. Research has shown that multi-site
pain in adolescence is a risk factor for the development of chronic pain in
adulthood, and that
dysmenorrhea (pain during menstruation) is a risk factor for persistent/chronic
pain. Cross-sectional studies consistently show higher levels of menstrual pain
intensity in individuals with chronic or persistent pain as compared to pain-free
controls, with a few
studies demonstrating dysmenorrhea as a precursor to chronic pelvic pain. Recent work has also shown higher levels of menstrual pain
intensity in adolescents with multi-site body pain. Therefore, it is critical to identify
potentially vulnerable individuals during adolescence, the time when dysmenorrhea
usually begins, in order to
provide effective treatments which may lessen the experience of widespread pain
during menstruation. Despite the likely contributions of both general pain widespreadness and
menstrual pain intensity to the development of future pain problems, less is known
about the extent of multi-site pain specifically during menstruation. Studies
investigating the link between dysmenorrhea and current or future pain problems have
been limited by only including measures of menstrual pain intensity, not the extent
of multi-site pain, in their analyses. Dysmenorrhea is often attributed to the lower
abdomen and pelvic regions as a result of physiological processes occurring in the
uterus. Many definitions of dysmenorrhea refer specifically to pain in the abdomen
and pelvis that may radiate to the back or thighs, likely due to the emphasis on the importance
of uterine contractions and prostaglandins in the process of menstruation. However, research has demonstrated
that pain occurs in other body regions during menstruation as well. Cordeiro
Rodrigues and colleagues used body maps to assess location of pain during
menstruation in young adult women with primary dysmenorrhea (mean age = 24.1, SD =
3.0) and found that most participants reported pain during menstruation in body
regions outside of the pelvis and lower abdomen. An expanded
understanding of pain occurring during menstruation, as opposed to the current use
of the term “menstrual pain,” may be needed in order to better
describe the lived experience of those with dysmenorrhea, which can then inform
future research and treatment approaches. Several studies in adolescents have included the assessment of pain location
during menstruation within the context of assessing menstrual cycle characteristics
and symptoms more generally. In one
population-based cohort study of 1,051 girls, headaches and lower back pain during
menstruation were reported by 64% and 58% of the sample, respectively. However, these studies typically
assess pain in a single item that includes other symptoms, making it impossible to
separate reports of pain, or with questionnaire items having a limited set of
pre-specified pain locations, which does not allow the respondent to report pain in
any except the listed locations. These methodologies do not fully address the
dimensionality of pain experienced during menstruation. No known research has used a
body map with adolescents to assess the location of pain during menstruation or
measured the extent of multi-site pain numerically based on the number of body
regions affected.