Pain is considered chronic when it persists for three or more months. It affects up to 30% of people worldwide. Chronic pain is difficult to treat once it has developed. Therefore, understanding which people might be at risk of developing chronic pain and protecting them from it starting, would be a really positive step forward.  

We know that women are more likely to develop almost all types of chronic pain than men. We start to see this sex difference in chronic pain after puberty, suggesting that changes happening at this time may be contributing to this increased risk. One important change that happens at this time is periods starting. Despite periods often being very painful, period pain has traditionally been dismissed as “normal” and something girls must learn to live with.  

However, in adult women with period pain we see many differences across a range of body systems when compared to women without period pain. These include increased sensitivity to pain; increased sensitivity of the bladder, bowel and womb; altered brain structure and function; and altered responses to stress. Similar changes to those seen with period pain can be seen in other chronic pain conditions. We don’t know whether these changes are caused by repeated or continuous pain or if they are part of the reason why chronic pain develops, or a combination of both. 

Aim 2 will involve recruiting new participants to the study. As part of this we will carry out testing of pain-relevant systems and brain scans at two different times during the menstrual cycle (once during a period and once around 10 days after a period).  

Aims 1 and 3 will be addressed using data collected in the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC is a large research resource which has been collecting data from children born in the early 1990s and their parents for almost 30 years. 

We hope this work will reduce the risk of both adolescent girls and adult women suffering with period pain and other chronic pain conditions. We will use what we learn about the long term risks of period pain, including how long it takes for experiencing period pain to increase your risk of chronic pain, to make sure period pain is taken seriously and to produce advice and guidance for those with period pain, health professionals, policy makers and educators. A better understanding of the risk factors for developing period pain when periods start will let us identify girls at risk of early-onset period pain, thereby ensuring they are educated and empowered to seek treatment early. Any findings about whether or how period pain leads to chronic pain will be developed into novel strategies to prevent chronic pain, including future work with other researchers and drug companies. 

In the RoADPain study, the project team shown below are trying to learn more about period pain in young people. It is really important that this research is guided and shaped by young people and people who have experienced period pain. This includes helping advise on what questions are asked, how people are invited to be part of our research, helping make sense of what the study finds out and how best to communicate about the results. This process is called patient and public involvement and engagement, often shortened to PPIE. PPIE makes health research better and makes sure that it is relevant to the people who the research is for and about.  

If you would be interested in finding out more about becoming a PPIE adviser for RoADPain, please email us. Your involvement could be as flexible as needed, to make this work well for you. It would not be a huge commitment (approximately 3 x 1hour long online meetings per year, which will be arranged for times convenient for you), and you could drop in and out as your interest and time allowed. Any time you spend on this, including online meetings or reading documents, would be reimbursed in line with the NIHR guidance.

• Emma Cox, CEO Endometriosis UK
• Kate Stein, Child and Adolescent Psychiatrist, Department of Psychiatry, University of Oxford  
• Gemma Sharp, Associate Professor in Reproductive and Mental Health Epidemiology, University of Exeter
• Sharon Dixon, NIHR Doctoral Research Fellow and General Practitioner, Nuffield Dept of Primary Care Health Sciences, University of Oxford
• Maryann Noonan, Lecturer, Department of Psychology, University of York
• Mina Fazel, Professor of Adolescent Psychiatry, Department of Psychiatry, University of Oxford 
• Omero Poli Netto (Visiting Senior Research Fellow)