Background

Many adults have chronic pain. Women report having more chronic pain than men, and they are at a greater risk for many pain conditions and impact their on quality of life. Chronic pain is not always curable, but treatments can help. A decrease in estrogen levels associated with menopause or iatrogenic effects (hysterectomy etc), as well as mutations of genes responsible for the synthesis of structural components of membrane estrogen receptors (ESR1 and ESR2), can significantly reduce the positive effects of these hormones. Deficiency of estrogen can become one of the reasons for the formation of chronic pain associated with the pathology of the musculoskeletal system. Multidisciplinary Pain Programs (MPPs) follow a model of care for overall quality of life improved. MPPs have been extensively documented in the standard medical literature. Most of the studies followed a biopsychosocial model of chronic pain, including treatment components in each of four areas: medical, behavioral, physical reconditioning, and education.

Methods

A sample of twelve women (43,5 ± 6 mean age) were studied in setting of pain therapy-SPOKE, Hospital “San Giovanni di Dio”- Frattamaggiore/ASL Napoli2Nord.  The patients with chronic pain diagnosis were divided in two groups: group I (menopause, N = 7) and group II (menopause for iatrogenic effects, N = 5). In two group, pain symptoms and chronic pain diagnostic criteria were investigated with IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11); with Numerical Pain Rating Scale (NPRS); a structured questionnaire and clinical interview were used to collect data of demographics, menopausal status, chronic diseases, reproductive history, etc; Brief Pain Inventory (BPI) and Graded Chronic Pain Scale-Revised for pain intensity.

Results

When groups I and II were compared, differences were found for pain symptoms. When analyzing the general group, the symptoms prevalence were greater in Group II. In group II the more common painful points were the lower back (49.5%), neck (38%) and widespread pains (71%). The more frequent symptoms were non-restful sleep (66%), followed by fatigue (57,6%) and cognitive symptoms (42%) and upper back (32.1%) in group I.                                              

The pain intensity was greater in group II (89%). The patients Group I exhibit significant pain catastrophizing, found in the structured questionnaire and clinical interview.

Discussion

The menopausal transition is associated with an increased frequency of disturbances. Widespread pains and insomnia represent the most reported symptoms by menopausal women. Women are more likely than men to suffer chronic pain, with the highest rates seen in midlife. The symptoms that characterize menopause broadly affect health and well-being, but their contribution to chronic pain risk during this period is poorly understood. Therapeutic strategies encompass different treatments. For an appropriate treatment of chronic pain, specific symptom clusters are important, because they guide the choice of treatment. There are differences between self-perception and other-perception of pain.

Conclusion

This study provides important insights to treat with specificity in chronic pain related symptoms in menopause status that need of Multidisciplinary Pain Programs (MPPs) for individual treatment. Chronic pain patients in menopause are best managed by a multidisciplinary team. Further studies are needed to elucidate the differences between menopause and menopause for iatrogenic effects, menopausal symptoms and chronic pain and their management.

References

-Carolyn J Gibson et al.; “Menopause symptoms and chronic pain in a national sample of midlife women veterans” Menopause. 2019 Jul; 26 (7):708-713;

-Roger B Fillingim et al.; “Assessment of Chronic Pain: Domains, Methods, and Mechanisms”J Pain 2016 Sep ;17 (9 Suppl):T10-20;                                                                                                                                    

-Rolf Detlef Treede “Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11) ” Pain 2019 Jan;160(1):19-27;

-Robin J Bell “Chronic pain and menopausal symptoms” Menopause. 2019 Jul;26(7):694-695;

-ON Pamuk et al.;“Chronic pain and menopausal symptoms ”Clin Exp Rheumatol 2005 Nov-Dec;23(6):778-82.

-T S Panevin et al.; “Endogenous estrogen deficiency and the development of chronic musculoskeletal pain: A review ” Ter Arkh 2022 Jun 17;94(5):683-688.

Acknowlegements

Beth Darnall, PhD | Professor Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine Director, Stanford Pain Relief Innovations Lab, 1070 Arastradero Road, Suite 200, MC 5596 Palo Alto, CA 94304 Fax: (650) 725-9642 - https://profiles.stanford.edu/beth-darnall  - Executive Assistant: Ashley Gomez [email protected]; for sending study and article «Development and Validation of a Daily Pain Catastrophizing Scale».