Menstrually related mood disorders and a history of abuse: moderators of pain sensitivity.

OBJECTIVE Women with a menstrually related mood disorder (MRMD) have substantially higher rates of physical and sexual abuse and are more sensitive to experimental pain stimuli than women without a MRMD. For the first time, this study examined pain sensitivity and hormonal correlates in women with a MRMD and in non-MRMD controls as a function of abuse history. METHODS A total of 126 women (63 with MRMD, 34 with an abuse history; and 63 non-MRMD, 31 with an abuse history) were evaluated for: (1) sensitivity to cold pressor and forearm ischemic pain and (2) basal plasma cortisol and norepinephrine (NE) concentrations. Exploratory analyses examined relationships between plasma cortisol and NE concentrations and pain sensitivity. RESULTS Women with a MRMD and an abuse history showed increased sensitivity to both cold pressor and ischemic pain and lower basal cortisol concentrations, an effect not seen in the women without a MRMD. In all women, the expected relationship between greater plasma cortisol concentration and reduced sensitivity to pain was observed, whereas NE predicted pain sensitivity only in women with a MRMD. CONCLUSIONS Menstrually related mood disorder status moderates the effect of a history of abuse on pain sensitivity. The results also suggest that the hypocortisolemia documented in the women with a MRMD and an abuse history may contribute to their greater sensitivity to noxious pain stimuli. This study adds to a growing body of evidence suggesting that a history of abuse may identify a clinically distinct subgroup of women with a MRMD.