Nerdy stuff: menstruation, hormones, pregnancy, and pain


This is a brain-dump and research-blurch I just did for a compatriot. These are issues that come up occasionally — every 28 days, for many — and always deserve good answers. Lots of links to scientific articles here.

Mouse brain neurons, two pairs, stained flame yellow against red background
Image by neurollero on flickr, CC share-alike attribution license.
There has been little research on women’s experiences of CRPS in terms of menstruation and pregnancy & breastfeeding. Gee, surprise surprise!
So I’m working to come at the issue sideways: looking for info on hormonal changes during menstruation & during pregnancy, and the effects that those hormones have on deep or central pain. Tedious, but possible. 
Also, I only have access to those articles which are publicly available. Many are kept under wraps because it’s one way that labs protect their intellectual property, sigh. 
PAIN & CHEMICAL-MESSENGER BASICS

Pain-related cytokines (this is old information, so these studies are old, but still informative):
“Recent findings on how proinflammatory cytokines cause pain”
https://www.sciencedirect.com/science/article/abs/pii/S0304394003013879
This article specifically cites 3 main culprits in neuropathic pain: IL-1beta (interleukin 1-beta), IL-6 (interluekin 6), and TNF-alpha (tumor necrosis factor alpha, which does a lot more than kill tumors!)

The publicly-available articles on cytokines’ role in pain are abundant from the early part of the millenium (1999-2010) but seem to disappear after 2013. I assume a lot of patentable activity is going on about it now, and given the usual lead-time on drug development, may not be available even for human trials for at least 5 more years.
Your pain specialist should be able to pull up more recent articles to share with your OB-GYN about that.

“Oxytocin – A Multifunctional Analgesic for Chronic Deep Tissue Pain” 2015
https://www.ingentaconnect.com/content/ben/cpd/2015/00000021/00000007/art00008

“Oxytocin and the modulation of pain experience: Implications for chronic pain management” 2015
https://www.sciencedirect.com/science/article/pii/S0149763415001177

MENSTRUAL CYCLE

Pain-related cytokine & hormonal changes around menstruation:
“Impact of Gender and Menstrual Cycle Phase on Plasma Cytokine Concentrations”
https://www.karger.com/Article/Abstract/107423
Women always have more pain cytokines than men, but they have more still during the luteal phase of the cycle, right after the egg is released (a.k.a. premenstrual phase) and leads to menses.

Since there’s so little science on menstruation in those with pain disorders, I include an article on menstruation & cytokines which explicitly draws a conclusion that *menstrual tissue itself* is the cytokine trigger (and endometriosis is basically an exaggeration of it), a conclusion which does support our experience of higher levels of CRPS pain with menses:
“Menstruation pulls the trigger for inflammation and pain in endometriosis”
https://www.sciencedirect.com/science/article/abs/pii/S0165614715000449

PREGNANCY & BREASTFEEDING

Breastfeeding confers protection against noxious brain chemistry:
“A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health”
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6
Has loads of references. It’s from 2007, but it’s so approachable I want you to have it anyway. Besides, the chemistry of our bodies hasn’t changed, only our understanding has increased.

Here’s an update by the same original author:
“The new paradigm for depression in new mothers: Current findings on maternal depression, breastfeeding and resiliency across the lifespan” 2015
https://search.informit.com.au/documentSummary;dn=283392990281695;res=IELHEA
It may be risky to include this, depending on your OB/GYN, because of the brutalizing confusion and ignorance around depression — widely seen as a character flaw and sign of weakness, when it’s just an overwhelming neurochemical state, and incidentally overlaps significantly with the overwhelming neurochemical state of neurogenic/central pain. In short, things that alleviate/mitigate depression also usually alleviate/mitigate central pain. It’s very simple.

GOOD TO KNOW

Let me give you two names to pass on to doctors willing to learn, for great info on CRPS: R.J. Schwartzmann, who retired in 2012 but whose work remains the most intelligent and articulate among CRPS researchers; and currently Breuhl and van Rijn are doing good work too.
More articles listed here by a trained 2dary researcher: https://elleandtheautognome.wordpress.com/crps-frequently-asked-questions-faq/

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