P-007 - (Poster #7) A Systematic Review of the Relationship Between 3 Acute Pain States in Women and Mental Health

Women’s mental health and experiences of pain are often underdiagnosed and underserved. Women frequently report higher levels of pain than men in acute settings but receive less effective pain management from providers.¹ This disparity is particularly relevant given that two of the most prevalent pain conditions nationally are back pain and headache, which disproportionately emerge in women.² Furthermore, women experience unique pain due to their anatomy and menstrual cycle, with up to 90% of women worldwide reporting abdominal pain and cramping prior to and during menstruation.³ In addition to these experiences of acute pain, women are at increased odds of developing mental health conditions when compared with men.⁴ While a relationship between chronic pain and worsened mental health is well established⁵, the relationship between acute pain and mental health is largely unexplored, even though acute pain affects a greater portion of the population.⁶

Purpose/Objectives:

Our purpose was to investigate whether a relationship exists between three prominent and common acute pain states (back pain, headache, menstrual pain) and mental health conditions in women. We hypothesized that increased frequency or severity of acute pain would be associated with increased prevalence or severity of mental health symptoms.

Methods:

We performed a systematic review of the available literature in PubMed up until February 2025, that included specific terms for mental health, acute pain, and women. The mental health search terms included were depression, anxiety, mental health, QoL, or stress. The acute pain search terms were dysmenorrhea, menstrual pain, menstrual cramp, back ache, back pain, or headache. We included papers that pertained to migraines, as the experience of migraine headache is acute. We excluded any papers pertaining to endometriosis, chronic pelvic pain, fibroids, or PCOS. We also excluded pregnant and postpartum populations, veterans, and populations of chronic medical conditions. We limited our results to primary cross-sectional, case-control, and cohort analyses, and literature available in English. Our specific search query yielded 1378 articles, and 550 articles were screened after applying exclusion criteria.

Results:

Out of 550 articles, we included 25 observational research studies investigating the relationship between acute pain states in women and mental health. Among these studies, 6 focused on back pain, 12 on headache, and 7 on menstrual pain. We found a relationship between back pain and mental health conditions, specifically depression and quality of life (QoL). Increased severity of back pain was associated with higher levels of depressive symptoms and lower QoL scores, most prominently among postmenopausal women. Headaches and migraines were associated with anxiety and depression in women of all ages across different populations. Increased headache frequency was correlated with higher rates of anxiety, depressive symptoms, stress, and lower quality of life symptoms. In the case of menstrual pain, women experiencing premenstrual syndrome (PMS) reported common mental health conditions, including anxiety and depression. Menstrual pain intensity was also associated with higher levels of psychological distress and poorer quality of life, notably among university students and working women.

Conclusions/Implications for future research and/or clinical care:

Based on our systematic review of the relationship between 3 acute pain states discussed and mental health, we can conclude that experiencing acute pain is associated with worsened mental health in women. Specifically, experiencing back pain, headache, or menstrual pain have all been associated with increased rates of depression, anxiety, and decreased quality of life. Headache and menstrual pain have additionally been linked to increased rates of stress. The experience of both pain and mental health change is subjective, and evidence suggests this relationship may be bidirectional⁷; however, suitable, accessible treatment options are underdeveloped and lack meaningful research to support their use. Many patients may delay treatment for acute pain to see how it progresses or resolves on its own. However, delaying treatment has the potential to lead to more significant issues including mental distress. Treating acute pain early and effectively may be necessary to avoid lingering mental health disturbances or worsening of mental and physical conditions. Future research should seek to determine whether providing early and effective acute pain management can offset or improve mental health in women.

References: 1. doi:10.1016/j.jopan.2022.09.004 2. https://dx.doi.org/10.15620/cdc:107894 3. https://www.iasp-pain.org/resources/fact-sheets/pain-in-women/  4. doi:10.1016/S2215-0366(16)30348-0 5. doi:10.1016/j.mayocp.2016.04.029 6. doi:10.1016/j.jpain.2015.05.002 7. doi:10.3389/fpain.2024.1445280