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Pain, Sleep, and Affective Symptoms in Primary Dysmenorrhea: A Symptom Network and Insular Connectivity Study

Year: 2026

Type: article

Abstract: Background: Primary dysmenorrhea (PDM) is a prevalent gynecological pain condition frequently accompanied by sleep disturbance and affective symptoms. Although neuroimaging studies have reported altered brain function in PDM, how menstrual pain relates to its multidimensional symptom profile remains incompletely understood. Methods: A total of 113 women with PDM and 105 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging during menstruation. Clinical symptoms, including the Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Pain Catastrophizing Scale (PCS), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were assessed using standardized questionnaires. Symptom network analysis was performed to identify core clinical symptoms in PDM. Subsequently, seed-based resting-state functional connectivity (rs-FC) analyses of insular subregions were conducted. Associations between altered insular connectivity and core clinical symptoms were further examined in patients with PDM. Results: Symptom network analysis identified sleep disturbance and affective symptom dimensions as central or bridging features within the clinical symptom network of PDM. Compared with HCs, patients with PDM exhibited increased rs-FC between the ventral anterior insula (vAI) and regions involved in salience and cognitive–emotional processing. Exploratory Spearman correlation analyses revealed nominal positive associations between right vAI–anterior cingulate cortex (ACC) connectivity and sleep disturbance ( ρ = 0.21, uncorrected P = 0.026) and anxiety ( ρ = 0.26, uncorrected P = 0.005). However, neither association survived FDR correction for multiple comparisons (adjusted P = 0.194 and 0.075, respectively). Conclusion: These findings suggest that altered anterior insula functional connectivity may represent a neural correlate of sleep disturbance and affective symptoms in PDM. Integrating symptom network analysis with insula-centered functional connectivity analysis offers complementary perspectives on menstrual pain and its co-occurring symptoms. Keywords: primary dysmenorrhea, resting-state fMRI, insula, functional connectivity, symptom network

Source: Journal of Pain Research

DOI: 10.2147/jpr.s641007