Innovative mixed methods for assessing chronic pain in adolescents and adults
Keywords: functional connectivity
mixed-method research
quantitative sensory testing
stress
trauma
chronic pain
endometriosis
dysmenorrhea

Chronic pain is a global concern that profoundly impacts the lives of millions, particularly among adolescent and young adult females. This doctoral thesis explores the intricate interplay between life experiences, emotional well-being, and the physiological ramifications of pain. While numerous conditions contribute to chronic pain in women, this thesis focuses specifically on two prevalent conditions: primary dysmenorrhea and endometriosis. By delving into these specific conditions, I aim to deepen understanding and enhance the care provided to women suffering from primary dysmenorrhea or endometriosis-related pain—both of which can be debilitating and regrettably remain without a cure.
The innovative nature of my approach integrates mixed methods and cutting-edge technology to study pain in adolescent and adult women. By amalgamating diverse research approaches and incorporating advanced techniques such as functional near-infrared spectroscopy and offset analgesia, which have not previously been applied to young women with dysmenorrhea or endometriosis, I introduce pioneering methods to pain assessment. This may mark a significant stride forward in the field with the potential to yield novel insights for understanding and managing pain in this population.
Chapter Two underscores the necessity for further exploration and suggests that females may exhibit distinct responses to experimental pain during different phases of their menstrual cycle. Chapter Three presents a comprehensive mixed-method cross-sectional study examining the intricate relationships between dysmenorrhea, endometriosis-related pain, pain inhibition, functional connectivity, pain catastrophising, resiliency, and adverse childhood experiences among young adults. Finally, Chapter Four reports longitudinal data collected at three-time points, assessing the stability of pain catastrophizing from ages 12 to 16 and exploring whether elevated pain catastrophising at age 12 predicts the development of generalised chronic pain and dysmenorrhea in female adolescents.
The findings show the critical role of considering adverse childhood experiences and altered functional connectivity in diagnosing and treating dysmenorrhea and endometriosis-related pain, as these factors may exacerbate and perpetuate pain into adulthood. While this area of research is still in its nascent stages, the ability to manipulate these factors may hold potential as a causal influence on pain experiences. The results also highlight the significance of pain catastrophizing in these populations. However, caution should be exercised when applying these findings in pain-free populations. Although pain catastrophizing is easy to measure in the lab, it may hold different clinical relevance for predicting pain in healthy individuals. Therefore, it is recommended that the clinical use of pain catastrophizing as a predictive tool be approached with discretion, particularly in pain-free populations.
Synthesizing the insights from these chapters provides a holistic understanding: chronic pain in women is a multifaceted phenomenon shaped by a convergence of biological, environmental, psychological, and social factors. This knowledge paves the way for future research and interventions targeting specific neuro-biopsychosocial model elements to enhance well-being and alleviate the burden of chronic pain in women.