Purpose: To consolidate and advance translational and clinical research and treatment programs aimed at improving health in areas related to pain disorders that disproportionately affect women.
Focus: The Institute for Neurological Disorders, based on the KUMC campus, has considerable strengths in several areas of brain health including pain disorders that are highly prevalent in women. As a part of this larger effort, very broad expertise can be brought to bear in solving disorders that affect the nervous system, including chronic pain.
Three areas that serve as a focus for the Women’s Pain Division (WPD) are fibromyalgia and related deep musculo-skeletal pain syndromes, pelvic pain, and migraine headaches. Fibromyalgia and pelvic pain both occur 10 times more frequently in women than in men, while migraine is three times more prevalent in women.
The objective of the of the WPD is to obtain a better understanding of the biological bases of these pain disorders, to devise new strategies for treating them, and to facilitate access to better medical care centered on addressing female pain syndromes.
The WPD will achieve these objectives by coordinating basic and translational research with clinical trials and services to advance programs in diagnostics, prevention, drug development, and treatment.
Approaches: Women’s pain syndromes are complicated and probably involve multiple factors that include both genetic and environmental factors. The WPD aspires to address several aspects that are critical to the development and treatment of female pain syndromes.
Much anecdotal evidence suggests that pain disorders are often preceded by specific events or conditions. For example, fibromyalgia is sometimes preceded by a viral infection and precipitated and exacerbated by fatigue, lack of sleep and possibly nutritional factors. Similarly, migraines are often associated with hormonal changes occurring at the onset of puberty and during the normal reproductive cycle. Pelvic pain has also been tied to use of birth control at an early age and to menopause. With a better understanding of what triggers pain syndromes, we will be armed to develop strategies to prevent and treat these disorders. In fact, WPD researchers are already looking at the role of improved sleeping habits on progression of fibromyalgia.
Why do some pain disorders occur so frequently in women?
The reason why some pain disorders occur predominantly in women is unclear. However, a role of female reproductive hormones has been long suspected. Research by WPD investigators has shown that estrogen and related hormones do alter sensory responses to uncomfortable stimuli in animal models. Ongoing studies are aimed at determining the extent to which hormones may play a role in female pain disorders.
What is the biological basis of female pain disorders?
Many physicians still believe that pain syndromes such as fibromyalgia, migraine and pelvic pain are ‘all in the patient’s head’. In fact, there is mounting evidence that these pain syndromes are rooted deeply in the biology of the nervous system. Some types of pain are associated with increased amounts of certain proteins that can affect the excitability of pain-sensing pathways. Estrogen can affect both the amounts proteins that alter nervous system properties and can affect sensitivity of the nerves themselves. Some tissues that are affected in female pain syndromes have been shown to have greater than normal numbers of nerves. While this area of investigation is just emerging, WPD researchers have been aggressively investigating physical and chemical changes in the nervous system (neuroplasticity) associated with acute and chronic pain, and with changes in hormone status.
How can we better diagnose female pain disorders?
Because there may be no overtly obvious damage or deformity, female pain disorders are typically very difficult to diagnose. Indeed, this may contribute to the under-diagnosing of these very common pain syndromes. A major part of the problem is a lack of good markers for pain disorders. By better understanding the nature of female pain conditions, investigators at the WPD will be better positioned to identify markers of certain disease states, such as elevation of certain blood proteins, genetic modifications, and brain imaging patterns. ‘Biomarker’ identification will not only facilitate diagnosis but may predict which therapeutic approaches are best suited to a particular pain syndrome.
Can we develop therapeutic approaches that not only treat the symptoms but also the causes of female pain disorders?
Our ability to address some symptoms associated with female pain syndromes has advanced rapidly in recent years. In addition to behavioral management techniques that improve quality of life, this includes development and marketing of new drugs such as triptans for migraines and anti-seizure medications for pelvic pain and fibromyalgia. However, treatments to date are essentially all aimed at the symptoms rather than the causes. Researchers and physicians of the WPD take a multidisciplinary approach by applying information they obtain from investigating the mechanisms of women’s pain towards cures. These approaches include developing new strategies toward preventing triggers from initiating chronic pain, to the quest for identifying new drugs and behavioral interventions that can treat pain disorders by addressing the basic biological mechanisms.
WPD physicians and investigators are engaged in translational programs aimed at understanding female pain disorders. Each team focuses on specific pain disorders that are over-represented in the female population. These translational teams are composed of physicians and scientists with multidisciplinary interests and strengths in basic and clinical science skills. Members of these teams work closely to identify areas where there is an urgent need for better research and treatment in female pain disorders.
Fibromyalgia and related musculo-skeletal pain syndromes
Fibromyalgia is a chronic condition characterized by pain and tenderness of muscles, tendons and joints. Patients affected by the syndrome often suffer from chonic fatigue syndrome, and the majority has sleep disorders. It is most commonly diagnosed in women between 40 and 55, frequently in association with the onset of menopause. Ninety percent of patients with fibromyalgia are women, affecting up to 8 million women in the US. Related female-prevalent musculo-skeletal pain disorders include conditions such as osteoarthritis.
Migraine Headaches
Migraine headaches are characterized by a feeling of throbbing or pulsing, often on one side of the head. This is often accompanied by nausea and hypersensitivity to light, sounds, and smells. Approximately 75% of all migraine sufferers are women, and a change in hormonal status during the reproductive cycle is a frequent trigger. Some 30 million people in the US suffer from migraines.
Pelvic Pain
Pelvic pain is estimated to affect 17% of the adult female population, and over 90% of individuals with pelvic pain are women. This painful condition is sometimes associated with endometriosis in women of child-bearing age. However, one type of pelvic pain (vulvar vestibulitis) has been noted to occur following use of oral contraceptives at an early age, while another (dysesthetic vulvodynia) often occurs at the onset of menopause.
Jeanne A. Drisko, MD
Riordan Endowed Professor of Orthomolecular Medicine
Director, Program in Integrative Medicine
KUMC
Bioidentical hormones and nutrition; complimentary and alternative
medical approaches to women’s health issues
Nancy Hamilton, PhD
Associate Professor
Clinical Psychology
KU Lawrence
Roles of emotion and sleep in modifying chronic pain states
Beth Levant, PhD
Associate Professor
Pharmacology, Toxicology and Therapeutics
KUMC
Role of dietary factors in mood disorders associated with chronic
pain
Teresa D. Long, MD
Associate Professor
Psychiatry and Behavioral Sciences
KUMC
Treatment of chronic musculoskeletal pain in female patients
Kenneth McCarson, PhD
Associate Professor
Pharmacology, Toxicology and Therapeutics
KUMC
Central nervous system actions of female reproductive hormones
on pain pathways
Peter G. Smith, PhD
Director, Kansas Intellectual and Developmental Disabilities
Research Center
Director, Center for Neurological Disorders (Interim)
Professor of Molecular and Integrative Physiology
KUMC
Effects of estrogen on growth of pain-sensing nerves in muscle
and skin
Kimberly Templeton, MD
Associate Professor
Orthopedic Surgery
KUMC
Management of musculo-skeletal pain
Douglas Wright, PhD
Associate Professor
Anatomy and Cell Biology
KUMC
Effect of estrogen on muscular pain in a model of fibromyalgia
Nancy Berman, PhD
Professor
Anatomy and Cell Biology
KUMC
Pain pathways mediating migraine headache and the effects of
estrogen on pain signaling
Jennifer Bickel, MD
Assistant Professor
Neurology
KUMC
Prevention and treatment of migraine headaches
Kenneth McCarson, PhD
Associate Professor
Pharmacology, Toxicology and Therapeutics
KUMC
Central nervous system actions of female reproductive hormones
on pathways mediating headaches
Michael Rapoff, PhD
R.L. Smith Professor
Pediatrics
KUMC
Assessment and management of headaches
Robert K. Twilman, PhD
Clinical Associate Professor
Psychiatry and Behavioral Sciences
KUMC
Palliative care
Tomas L. Griebling, MD, MPH, FACS, FGSA
John P. Wolf 33° Masonic Distinguished Professor
Vice-Chair - Department of Urology
Diagnosis and treatment of pelvic pain including interstitial
cystitis and vulvodynia
Teresa D. Long, MD
Associate Professor
Psychiatry and Behavioral Sciences
KUMC
Treatment and assessment of chronic pelvic pain in female patients
Linda R. Nelson MD, PhD
Associate Professor
Obstetrics and Gynecology
KUMC
Causes and treatment of endometriosis and associate pain
Peter G. Smith, PhD
Director, Kansas Intellectual and Developmental Disabilities
Research Center
Director, Center for Neurological Disorders (Interim)
Professor of Molecular and Integrative Physiology
KUMC
Changes in reproductive tract innervation associated with pelvic
pains syndromes
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The University of Kansas Medical Center