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Peer-reviewedCC BY-NC 4.0Journal of Pain Research

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

  • Lu Yang1
  • Wei Wei1
  • Kuaile Hu1
  • Qinhan Yang1
  • Youhao Gong1
  • Xiwen Qian1
  • Yuhan Tang1
  • Yunhua Si1
  • Qin Liu1
  • Fen Feng2
  • Siyi Yu1
  • Jie Yang1,2,3
  1. 1School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of China
  2. 2Department of Preventive Treatment of Disease, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of China
  3. 3Department of Traditional Chinese Medicine, West China Second University Hospital, Sichuan University/West China Women’s and Children’s Hospital, Chengdu, Sichuan Province, People’s Republic of China
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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.

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Cite

BibTeXRIS
BibTeX
@article{yang2026pain,
  title = {{Pain, Sleep, and Affective Symptoms in Primary Dysmenorrhea: A Symptom Network and Insular Connectivity Study}},
  author = {Lu Yang and Wei Wei and Kuaile Hu and Qinhan Yang and Youhao Gong and Xiwen Qian and Yuhan Tang and Yunhua Si and Qin Liu and Fen Feng and Siyi Yu and Jie Yang},
  journal = {Journal of Pain Research},
  year = {2026},
  month = nov,
  doi = {10.2147/jpr.s641007},
  url = {https://doi.org/10.2147/jpr.s641007},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Pain, Sleep, and Affective Symptoms in Primary Dysmenorrhea: A Symptom Network and Insular Connectivity Study
AU  - Lu Yang
AU  - Wei Wei
AU  - Kuaile Hu
AU  - Qinhan Yang
AU  - Youhao Gong
AU  - Xiwen Qian
AU  - Yuhan Tang
AU  - Yunhua Si
AU  - Qin Liu
AU  - Fen Feng
AU  - Siyi Yu
AU  - Jie Yang
PY  - 2026
DA  - 2026/11/03
JO  - Journal of Pain Research
DO  - 10.2147/jpr.s641007
UR  - https://doi.org/10.2147/jpr.s641007
AB  - 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.
SN  - 1178-7090
ER  -