The candidate for the proposed Mentored Patient-Oriented Research Career Development Award (K23) entitled 'Central Pain Mechanisms in Primary Dysmenorrhea'is a clinical instructor at the David Geffen School of Medicine at the University of California, Los Angeles. This five year award is expected to help the candidate transition to an independent career as a clinical scientist and to expand on the candidate's background and training in pediatric pain by exploring central pain mechanisms in adolescent girls and young adult women with primary dysmenorrhea (PD). The candidate's immediate career goals are to gain training and research experience in women's health and chronic pelvic pain (specifically, dysmenorrhea), using complex pain assessment techniques designed to evaluate excitatory and inhibitory central pain processes, and salivary assessment and analysis of stress and sex hormones. Long-term career goals are to become an independent investigator with expertise in pain mechanisms related to women's health, advance the field of chronic pain by disentangling pain processes in a highly common but understudied condition (PD), and obtain data for an eventual R01 application focused on testing potential behavioral interventions for adolescents and adults with PD. The candidate has identified nationally renowned mentors as part of her mentoring team, including an expert in chronic pain in children, an obstetrician/gynecologist who specializes in pelvic pain, and a psychologist who is an authority on psychophysiological measurement of stress. Other members of the mentoring team will provide guidance in dysmenorrhea and the relationship of pelvic pain to other chronic pain conditions, and salivary assessment and analysis of stress and sex hormones. In addition to formal and informal mentoring, the candidate is located at a nationally recognized university and hospital, such that the career development plan includes attending reproductive endocrinology didactics and clinic, classes, seminars, and meetings in obstetrics/gynecology, psychophysiology of stress, qualitative research methods, ethical considerations for research subjects, grant writing and career development, and statistical approaches to data analysis. The candidate's proposed research involves comparing adolescent and young adult girls (ages 16-21) with and without PD during each of 3 phases of the menstrual cycle (menstruation, ovulatory, luteal) across a variety of standardized experimental pain testing paradigms designed to evaluate pain sensitivity and central excitatory and inhibitory mechanisms.
The specific aims for this project are: 1) to confirm previous findings of enhanced pain sensitivity in women with PD, 2) to evaluate differences in central excitatory and inhibitory pain modulation in women with and without PD, and 3) to test for differences in autonomic nervous system (ANS) and hypothalamic-pituitary axis (HPA) responses to pain in AYAs with and without PD, and 4) to assess the role of psychological factors (depression, anxiety, and emotion regulation) in relation to pain responses in both groups. This innovative study uses recently developed pain paradigms to better understand how and why adolescents and women with PD experience pain. In addition, this study is the first of its kind to explore pain responses in PD across the developmental spectrum, which has the potential to identify individuals at risk for the development of future chronic pain problems and inform new interventions and prevention strategies. The training and experience gained from the candidate's proposed research and career development plan will provide the critical early career support necessary for the candidate to fully develop as a successful independent researcher capable of obtaining extramural funding and establishing a long-term research career in women's health and pain.
Dysmenorrhea is a chronic and costly public health concern, affecting up to 90% of adolescent and adult women. The current study aims to better understand the potential role of central pain mechanisms, including excitatory and inhibitory pain responses, in dysmenorrhea. Results from this study may help identify girls and women at risk for the development of additional chronic pain problems and set the stage for creating new interventions focused on centralized pain processes, which have the potential of reducing disability, pain, and suffering in dysmenorrhea.