Multi-Site Pain During Menstruation in Adolescents is Associated With Impaired Functioning Across Various Domains: A Cross-Sectional Observational Study

Study Objective: To evaluate multi-site pain (i.e., number of painful body regions) during menstruation in a sample of adolescents, and to assess relationships between multi-site pain during menstruation and other menstrual cycle, pain, and psychosocial factors.

Participants in this cross-sectional observational study included 141 girls ages 13–19 years with varying levels of menstrual pain. Participants indicated on a body map the areas where they usually experience pain when menstruating. Participants also completed a set of validated self-report questionnaires. Menstruation-associated multi-site pain was calculated as the total number of body regions reported (out of 21). Partial correlations controlling for baseline menstrual pain intensity were conducted between menstruation-associated multi-site pain and other variables of interest.

The average number of body regions reported was 2.8 (SD = 1.5; min = 0; max = 8). Menstruation-associated multi-site pain was significantly positively correlated with number of pre-menstrual syndrome symptoms, non-menstrual multi-site body pain, pain interference over the prior week, fatigue, sleep disturbance, somatization, and multisensory sensitivity. Menstruation-associated multi-site pain was not significantly correlated with age, age at menarche, gynecologic age, menstrual pain interference, and non-menstrual body pain intensity.

Pain during menstruation in adolescents is not limited to the abdominal and pelvic regions, and many girls experience pain in numerous body locations during their periods. The associations between menstruation-associated multi-site pain and other pain and psychosocial measures provide preliminary evidence for the existence of a sub-group of adolescents who may be at increased risk for future pain problems.

Dysmenorrhea, Multi-site pain, Pain widespreadness, Adolescent

Multi-site pain (i.e., the number of painful body locations a person experiences, also known as pain widespreadness) is associated with central sensitization,1 which is defined as sensory amplification and impaired pain inhibition due to alterations in the central nervous system.2,3 Research has shown that multi-site pain in adolescence is a risk factor for the development of chronic pain in adulthood,4 and that dysmenorrhea (pain during menstruation) is a risk factor for persistent/chronic pain. Cross-sectional studies consistently show higher levels of menstrual pain intensity in individuals with chronic or persistent pain as compared to pain-free controls,5 with a few studies demonstrating dysmenorrhea as a precursor to chronic pelvic pain.6,7 Recent work has also shown higher levels of menstrual pain intensity in adolescents with multi-site body pain.8 Therefore, it is critical to identify potentially vulnerable individuals during adolescence, the time when dysmenorrhea usually begins,9 in order to provide effective treatments which may lessen the experience of widespread pain during menstruation. Despite the likely contributions of both general pain widespreadness and menstrual pain intensity to the development of future pain problems, less is known about the extent of multi-site pain specifically during menstruation. Studies investigating the link between dysmenorrhea and current or future pain problems have been limited by only including measures of menstrual pain intensity, not the extent of multi-site pain, in their analyses. Dysmenorrhea is often attributed to the lower abdomen and pelvic regions as a result of physiological processes occurring in the uterus. Many definitions of dysmenorrhea refer specifically to pain in the abdomen and pelvis that may radiate to the back or thighs,10 likely due to the emphasis on the importance of uterine contractions and prostaglandins in the process of menstruation.11 However, research has demonstrated that pain occurs in other body regions during menstruation as well. Cordeiro Rodrigues and colleagues used body maps to assess location of pain during menstruation in young adult women with primary dysmenorrhea (mean age = 24.1, SD = 3.0) and found that most participants reported pain during menstruation in body regions outside of the pelvis and lower abdomen.12,13 An expanded understanding of pain occurring during menstruation, as opposed to the current use of the term “menstrual pain,” may be needed in order to better describe the lived experience of those with dysmenorrhea, which can then inform future research and treatment approaches. Several studies in adolescents have included the assessment of pain location during menstruation within the context of assessing menstrual cycle characteristics and symptoms more generally.14–16 In one population-based cohort study of 1,051 girls, headaches and lower back pain during menstruation were reported by 64% and 58% of the sample, respectively.16 However, these studies typically assess pain in a single item that includes other symptoms, making it impossible to separate reports of pain, or with questionnaire items having a limited set of pre-specified pain locations, which does not allow the respondent to report pain in any except the listed locations. These methodologies do not fully address the dimensionality of pain experienced during menstruation. No known research has used a body map with adolescents to assess the location of pain during menstruation or measured the extent of multi-site pain numerically based on the number of body regions affected. The aims of the current study are therefore to: 1) describe the spatial pattern of pain experienced during menstruation by adolescents with varying levels of menstrual pain, including frequencies of reporting for specific body regions and the overall extent of multi-site pain; and 2) investigate the relationships between multi-site pain during menstruation and other menstrual and psychosocial domains. We hypothesized that, consistent with existing literature, adolescents would most frequently report dysmenorrhea pain in the abdomen and pelvic regions, but that other body regions would be reported as painful by a smaller but substantial minority of girls. We hypothesized that the number of painful body regions during menstruation would be associated with indices of central sensitization,1 including multisensory sensitivity, fatigue, sleep disturbance, somatization, and the extent of non-menstrual multi-site body pain.

Participants Participants in this cross-sectional observational study included 141 girls ages 13–19 years with varying levels of menstrual pain who were participating in a study investigating behavioral and neural phenotypes of dysmenorrhea in adolescents.17 See Figure 1 for recruitment and enrollment flowchart. Inclusion criteria included: (1) female aged 13–19 years; (2) self-reported menstrual cycle averaging 22–35 days; (3) regular menstrual cycles for at least 6 months, (4) access to a smartphone or email; (5) right-handed; (6) body mass index (BMI) of 35 or less; (7) able to read and understand English. Select exclusion criteria included: (1) use of oral contraceptives or any exogenous hormones in the previous 3 months prior to participation; (2) presence of factors indicative of secondary dysmenorrhea (e.g., self-reported presence of persistent pelvic pain throughout the month); (3) diagnosis of chronic pain condition (e.g., irritable bowel syndrome (IBS), functional abdominal pain, chronic migraines); (4) current or past diagnosis of any psychotic disorder; (5) currently pregnant; (6) self-reported weekly use of alcohol, cannabis, and/or other illegal substances; (7) history of pelvic inflammatory disease or sexually transmitted disease; (8) developmental delay, diagnosis of autism, or significant cognitive impairment that may preclude understanding of study procedures. Full exclusion criteria are available in Supplemental File 1. Procedure Participants were recruited from social media advertisements, online advertisements, and by word of mouth. Recruitment occurred between October 2020 and October 2023; data collection for the current analyses occurred between December 2020 and December 2023. Potential participants were screened for eligibility by telephone. Minor participants (ages 13–17) completed the telephone screen with a parent present; parents completed signed permission forms and minors completed signed assent forms at an in-person intake visit, which occurred during any menstrual cycle phase. Participants ages 18 and older completed written informed consent at the intake visit. A study visit was then scheduled to occur during the mid-follicular phase (i.e., days 8–14) of the upcoming menstrual cycle. Questionnaires were completed using the Research Electronic Data Capture (REDCap)18,19 survey platform. Study visits also included a functional magnetic resonance imaging (fMRI) session17 and quantitative sensory testing. Participants were compensated $25 for the intake visit and $125 for the study visit. All study procedures were approved by the Mass General Brigham institutional review board under protocol #2019P001729; the study was registered on clinicaltrials.gov as protocol NCT04685343. Measures Intake Demographics and menstrual history. Demographic and menstrual history variables were assessed using a questionnaire designed for this study. Baseline menstrual pain intensity and daily life interference due to menstrual pain (“menstrual pain interference”) were both assessed on a 0 (no pain/not at all) to 10 (worst pain possible/interferes completely) numeric rating scale (NRS).20,21 Number of pre-menstrual syndrome (PMS) symptoms were summed from a list of 21 items from the Daily Record of Severity of Problems, which is used to assess PMS and to aid in the diagnosis of pre-menstrual dysphoric disorder based on criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).22 Menstruation-associated multi-site pain. Participants completed the Collaborative Health Outcomes Information Registry (CHOIR)23 body map in response to the question “Where on your body do you usually have pain during your period? (select all that apply).” The CHOIR body map has been shown to be valid for use with children and adolescents24 and was integrated as an image into the RED-Cap survey such that participants were able to click on the body locations they wanted to report. The front and back of the body are presented side-by-side and are divided into 74 locations, which were collapsed into 21 regions based on previous research25 (see Supplemental File 2). Number of regions reported was used as the measure of menstruation-associated multi-site pain (MAMP). Participants without menstrual pain (i.e., those who answered ‘0’ on the pain intensity question) did not answer the body map question and their MAMP value was set as 0. Study Visit Non-menstrual body pain. Participants reported the locations of body pain they experienced during the prior month when not menstruating, which was quantified as above (“non-menstrual multi-site body pain”). Separately, pain intensity over the prior month when not menstruating was rated on the 0 (no pain) to 10 (worst pain possible) NRS (“non-menstrual body pain intensity”). Psychosocial functioning. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to assess various aspects of psychosocial functioning, including fatigue and pain interference (“past-week pain interference”) assessed in the Pediatric Profile v2.0 – Profile-4926 and sleep disturbance assessed with the Pediatric Short Form 8a v1.0.27,28 All 3 scales instruct participants to answer with regards to the prior 7 days. Items on each of these 8-item short forms are rated on a 5-point likert scale; item values are summed to yield total scale scores with higher scores representing more impairment. Internal consistencies in the current sample were α = 0.93 (fatigue), α = 0.91 (pain interference), and α = 0.89 (sleep disturbance). Multisensory sensitivity. The Sensory Hypersensitivity Scale (SHS)29 is a 25-item measure assessing participants’ sensitivity across the sensory spectrum (e.g., auditory, visual, pain, texture, etc.). Item answers range from 1 (strongly disagree) to 5 (strongly agree) and are averaged to yield the total scale score. Internal consistency in the current sample was α = 0.87. Somatization. The Children’s Somatization Inventory - 24-item Version (CSI-24)30 measures participants’ perceptions of nonspecific somatic symptoms (e.g., dizziness, constipation, etc.). Participants rate how much they were bothered by each of 24 symptoms during the prior 2 weeks. Items are rated on a 0 (not at all) to 4 (a whole lot) likert scale and summed to yield the total score. Internal consistency in the current sample was α = 0.87. Statistical Analyses Sample size was determined by the parent study, which was powered to determine the neural and behavioral phenotypes associated with developmental trajectories of menstrual and nonmenstrual body pain in adolescents. Descriptive statistics were used to assess the distribution of MAMP (i.e., number of body regions reported as painful) across the sample, and frequencies with which each body region was reported. Spearman’s rho correlation was first conducted to examine the relationship between MAMP and menstrual pain intensity. Subsequently, partial correlations controlling for menstrual pain intensity were conducted to elucidate relationships between MAMP and the menstrual and psychosocial variables of interest. Missing data was imputed as long as at least 80% of the items on the scale were answered. Analyses were conducted using SPSS version 28.0 (IBM Corp).

The average participant age was 17.2 years (SD = 1.9) and average age of menarche was 12.0 years (SD = 1.2). On average, participants had been menstruating for 5.3 years (SD = 2.2) and had a baseline menstrual pain rating of 5.4 (SD = 2.2). The average cycle length was 30.2 days (SD = 3.3). Average MAMP was 2.8 (SD = 1.5; min = 0; max = 8). See Table 1 for additional demographic and menstrual history characteristics and a breakdown of MAMP scores. The most frequently reported body regions were: groin (76.6%), abdomen (72.3%), and low back (48.9%). When taken together, 96.5% of participants reported either groin or abdomen (or both). See Table 2 and Figure 2 for frequencies of all body regions. Table 1. | Age (years) - mean (SD) [min-max] | 17.2 (1.9) [13.1–19.9] | | Ethnicity – n (%) | | | Hispanic/Latino | 15 (10.6) | | Non-Hispanic/Non-Latino | 126 (89.4) | | Race – n (%) | | | White | 77 (54.6%) | | Black/African-American | 14 (9.9%) | | Asian | 31 (22.0%) | | American Indian/AK Native | 1 (0.7%) | | Multiracial | 17 (12.1%) | | Does not identify with options | 1 (0.7%) | | Menstrual pain intensity – mean (SD) [min-max] | 5.4 (2.2) [0–9] | | Average cycle length (days) – mean (SD) [min-max] | 30.2 (3.3) [22.0–45.0] | | Menarche age (years) – mean (SD) [min-max] | 12.0 (1.2) [9–15] | | Gynecologic age (years) – mean (SD) [min-max] | 5.3 (2.2) [0.25–10.1] | | Dysmenorrhea onset after menarche – n (%) | | | Immediately | 28 (19.9) | | 1–6 months | 55 (39.0) | | 7–12 months | 20 (14.2) | | > 12 months | 37 (26.2) | | Never experienced menstrual pain | 1 (0.7) | | Pain duration during menstruation– n (%) | | | 1–2 days | 102 (72.3) | | 3–4 days | 33 (23.4) | | 5 or more days | 6 (4.3) | | MAMP – mean (SD) | 2.8 (1.5) | | MAMP (number of regions) – n (%) | | | 0 | 3 (2.1) | | 1 | 25 (17.7) | | 2 | 38 (27.0) | | 3 | 36 (25.5) | | 4 | 25 (17.7) | | 5 | 9 (6.4) | | 6 | 0 (0.0) | | 7 | 2 (1.4) | | 8 | 3 (2.1) | MAMP, menstruation-associated multi-site pain. Table 2. | Body region | Frequency of reporting [n (%)] | |---|---| | | | | Head | 29 (20.6) | | Face | 1 (0.7) | | Neck | 2 (1.4) | | Shoulder | 3 (2.1) | | Chest | 29 (20.6) | | Upper Arm | 0 (0) | | Elbow | 0 (0) | | Forearm | 0 (0) | | Wrist | 0 (0) | | Hand | 0 (0) | | Abdomen | 102 (72.3) | | Hip | 11 (7.8) | | Groin | 108 (76.6) | | Upper Leg | 14 (9.9) | | Knee | 1 (0.7) | | Lower Leg | 2 (1.4) | | Ankle | 4 (2.8) | | Foot | 1 (0.7) | | Upper Back | 3 (2.1) | | Mid Back | 13 (9.2) | | Low Back | 69 (48.9) | | Either abdomen or groin (or both)* | 136 (96.5) | Of the 2 individuals whose menstrual pain NRS was >0 but did not report either abdomen or groin, 1 was low back only, 1 was chest + upper leg + lower leg + low back. MAMP was positively correlated with baseline menstrual pain intensity (ρ =.407, P <. 001) so future correlations controlled for baseline menstrual pain intensity. MAMP was positively correlated with number of PMS symptoms (ρ =.411, all P ’s ≤.001 unless otherwise indicated), non-menstrual multi-site body pain (ρ =.525), past-week pain interference (ρ =.296), fatigue (ρ =.226, P =. 007), sleep disturbance (ρ =.274), somatization (ρ =.395), and multisensory sensitivity (ρ =.217, P =. 010) (Table 3). MAMP was not significantly correlated with age, age at menarche, gynecologic age, menstrual pain interference, and non-menstrual body pain intensity. Table 3. | Measure | Measure score [M (SD)] | Correlation coefficient (sig.) | |---|---|---| | | || | Age | See Table 1 | 0.018 (ns) | | Age at menarche | −0.006 (ns) | | | Gynecologic age | 0.018 (ns) | | | Menstrual pain interference | 3.6 (2.4) | 0.001 (ns) | | Number of PMS symptoms*** | 6.9 (4.3) | 0.411** (0.000) | | Non-menstrual multi-site body pain | 1.7 (1.9) | 0.525** (0.000) | | Non-menstrual body pain intensity | 2.1 (2.0) | 0.122 (ns) | | Past-week pain interference | 13.5 (6.0) | 0.296** (0.000) | | Fatigue | 15.4 (7.0) | 0.226* (0.007) | | Sleep Disturbance | 15.0 (6.1) | 0.274* (0.001) | | Somatization | 13.3 (9.5) | 0.395** (0.000) | | Multisensory Sensitivity | 2.6 (0.6) | 0.217* (0.010) | MAMP, menstruation-associated multi-site pain; PMS, pre-menstrual syndrome; ns, not significant. P ≤ .01. P< .001 n = 140.

This study is the first known report using a body map in a sample of adolescents to assess the full body locations of pain during menstruation. As hypothesized, the lower abdomen and groin areas were the most frequently reported regions, though a number of other body regions were also reported. The frequencies with which other body regions were reported in the current study were lower than those reported in the only other study to use the body map to assess pain location during menstruation,12,13 which was conducted in young adults and found prevalence rates of 82.2% for lower back, 54.7% for head, 32.9% for breasts, 28.8% for leg, and 20.5% for hip, among others.13 While this study did not report on the average total number of locations reported, the higher prevalence across all locations would inherently yield higher MAMP scores than observed in the current study, supporting the theory that MAMP may increase into young adulthood, though results must be interpreted with caution due to variations in methodology. The current findings also assessed the total number of body regions reported (i.e., MAMP). Average MAMP in the current sample was 2.8, and over half of participants (53.2%) reported MAMP of 3 or higher, which has been considered multi-site pain in pediatric populations.31 Even using a more conservative definition of multi-site pain, a notable minority of the study population reported MAMP of ≥4 or ≥5 regions (27.7% and 9.9%, respectively). Consistent with our hypothesis of significant associations between MAMP and indices of central sensitization, adolescents experiencing greater MAMP experienced more impairment in functioning than their peers across a number of domains, including number of PMS symptoms, past-week pain interference, fatigue, sleep disturbance, somatization, multisensory sensitivity, and non-menstrual multi-site body pain, the latter of which is particularly notable because the two body maps were completed at separate visits. Research has found associations among widespread pain and many of these constructs in adolescents,8,32–34 but future research is needed to evaluate their relationships with MAMP. Taken as a whole, they are indicative of the potential for centrally-mediated processes to be involved in this phenomenon, of which MAMP may be one of a constellation of symptoms. The age span of participants in the current study is broad when considering the rapid changes occurring during puberty, however, MAMP was not correlated with age, age at menarche, or gynecologic age (i.e., the length of time an individual has been menstruating). The increasing MAMP across the lifespan is likely an important factor to consider, but these null findings demonstrate that MAMP in adolescents may result from factors outside the trajectory of pubertal development. Other findings of relevance include no correlations between MAMP and either non-menstrual body pain intensity over the prior month or menstrual pain interference. Taken in context, the significant positive correlation of MAMP with non-menstrual multi-site body pain (described above) and the lack of significant correlation between MAMP and non-menstrual body pain intensity further support the separation of pain intensity and pain widespreadness as related yet distinct phenomena. Separating MAMP from other assessments of pain and menstruation may yield critical insight. For example, body regions such as hip and mid back were less frequently reported (7.8% and 9.2%, respectively) in the current sample, but may represent an important vulnerable subgroup of adolescents that would not be revealed without the use of a body map. Therefore, given the ease of administration, we recommend exploring the use of body maps in both research and clinical practice to assess MAMP. A few limitations to the current study must be noted. First, the CSI-24 recall period is 2 weeks, which would have overlapped with bleeding days for all participants and perhaps captured some symptoms that were related to menstruation. The 7-day recall period for PROMIS measures was less likely to overlap with bleeding days for most participants. Recall of pain problems over the prior month may also be differentially affected by various psychosocial factors. The intake visit was not timed according to the cycle so cycle phase may have influenced responses to measures completed at that time point. The body map as administered does not allow for post-hoc interpretation of the chest region as intended to report breast pain vs. other pain in that region. In order to avoid assumptions, we have taken a conservative approach to interpreting those results. Lastly, we did not assess absenteeism from school or activities, which are important factors when considering the impact of menstrual pain on adolescents that should be included in future research assessing MAMP. Future research regarding MAMP should be conducted longitudinally beginning as close to menarche as possible. Recent work has assessed the effect of menarche on multisite pain,8 but these analyses did not include MAMP. This will enable researchers to assess the temporality of the development of MAMP, including identification of subgroups exhibiting similar patterns. Incorporating other psychosocial domains, such as sleep, somatization, physical and social functioning, etc. is essential to elucidate how these variables interact over time. Longitudinal research is also needed to assess how MAMP may be associated with the development of future pain problems. Lastly, population-level prevalence and impact studies of menstruation in adolescents should include items assessing menstrual pain experienced across the entire body, including total number of body regions affected.. Clinical implications include the need for thorough assessment of pain experienced during menstruation in adolescents. If future research reveals MAMP to be a risk factor for the development/worsening of pain, identifying this pattern in the primary care setting or early in specialty gynecologic care would allow clinicians to more aggressively provide coping and pain management strategies which may lessen the experience of widespread pain during menstruation. In conclusion, findings indicate that multi-site pain is common during menstruation in adolescents and that MAMP is associated with impairments in functioning across a variety of psychosocial domains. The conceptualization of pain during menstruation must expand beyond the pelvis, even in adolescence. By separating symptoms like headaches and back pain as separate items, instruments are perpetuating the concept that pain in those body regions is different than “menstrual pain,” which is located in the abdomen/pelvis. A broader understanding of pain occurring with menstruation may be more appropriate in both research and clinical assessment of menstrual pain. MAMP, separate from menstrual pain intensity and general pain widespreadness, should be included in models used for predicting pain and functioning outcomes. Supplementary Material Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.jpag.2025.10.009. Funding This research was supported by National Institutes of Health NICHD grant R01 HD093680 (PI: Laura A. Payne). This research was presented at the 27th Annual Scientific Meeting of the International Pelvic Pain Society, Cartagena, Colombia, October 17, 2024; and at the 2025 McLean Hospital Research Day, Belmont, MA, USA, January 22, 2025. Footnotes Declaration of competing interest Author LAP has received consulting fees from Bayer Healthcare, Mahana Therapeutics, and OR Health & Science University and speaking fees from Brightside Health, Pacific Rehabilitation Centers, and The Concord Center. Author LCS has no conflicts of interest to report.

- 1.Inoue S, Hashizume H, Murata S, et al. : Association between central sensitization and multisite pain in the general population: a cross-sectional analysis of The Wakayama Health Promotion Study. J Orthop Sci 2025. [DOI] [PubMed] [Google Scholar] - 2.Latremoliere A, Woolf CJ: Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009; 10(9):895–926. [DOI] [PMC free article] [PubMed] [Google Scholar] - 3.Woolf CJ: Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011; 152(3 Suppl):S2–S15. [DOI] [PMC free article] [PubMed] [Google Scholar] - 4.Murray CB, Li R, Kashikar-Zuck S, et al. : Adolescent predictors of young adult pain and health outcomes: results from a 6-year prospective follow-up study. Pain 2025; 166(1):42–51. [DOI] [PMC free article] [PubMed] [Google Scholar] - 5.Li R, Li B, Kreher DA, et al. : Association between dysmenorrhea and chronic pain: a systematic review and meta-analysis of population-based studies. Am J Obstet Gynecol 2020; 223(3):350–71. [DOI] [PubMed] [Google Scholar] - 6.Hardi G, Evans S, Craigie M: A possible link between dysmenorrhoea and the development of chronic pelvic pain. Aust N Z J Obstet Gynaecol 2014; 54(6):593–6. [DOI] [PubMed] [Google Scholar] - 7.Li R, Kreher DA, Jusko TA, et al. : Prospective association between dysmenorrhea and chronic pain development in community-dwelling women. J Pain 2021; 22(9):1084–96. [DOI] [PubMed] [Google Scholar] - 8.Osborne NR, Hellman KM, Burda EM, et al. : Multimodal hypersensitivity and somatic symptoms predict adolescent postmenarchal widespread pain. Pain 2025. [DOI] [PMC free article] [PubMed] [Google Scholar] - 9.Gagnon MM, Moussaoui D, Gordon JL, et al. : Dysmenorrhea across the lifespan: a biopsychosocial perspective to understanding the dysmenorrhea trajectory and association with comorbid pain experiences. Pain 2022; 163(11):2069–75. [DOI] [PubMed] [Google Scholar] - 10.Proctor M, Farquhar C: Diagnosis and management of dysmenorrhoea. BMJ 2006; 332(7550):1134–8. [DOI] [PMC free article] [PubMed] [Google Scholar] - 11.Ferries-Rowe E, Corey E, Archer JS: Primary dysmenorrhea: diagnosis and therapy. Obstet Gynecol 2020; 136(5):1047–58. [DOI] [PubMed] [Google Scholar] - 12.Rodrigues JC, Avila MA, Dos Reis FJJ, et al. : Painting my pain’: the use of pain drawings to assess multisite pain in women with primary dysmenorrhea. BMC Womens Health 2022; 22(1):370. [DOI] [PMC free article] [PubMed] [Google Scholar] - 13.Rodrigues JC, Avila MA, dos Reis FJJ, et al. : How does my pain look like? Characterizing dysmenorrhea-related pain using the body map. BrJP São Paulo 2023; 6(2):145–50. [Google Scholar] - 14.De Sanctis V, Soliman AT, Elsedfy H, et al. : Dysmenorrhea in adolescents and young adults: a review in different country. Acta Biomed 2016; 87(3):233–46. [PMC free article] [PubMed] [Google Scholar] - 15.Gambadauro P, Hadlaczky G, Wasserman D, Carli V: Menstrual symptoms and subjective well-being among postmenarchal adolescents. AJOG Glob Rep 2024; 4(1):100304. [DOI] [PMC free article] [PubMed] [Google Scholar] - 16.Parker MA, Sneddon AE, Arbon P: The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG 2010; 117(2):185–92. [DOI] [PubMed] [Google Scholar] - 17.Payne LA, Seidman LC, Napadow V, Nickerson LD, Kumar P: Functional connectivity associations with menstrual pain characteristics in adolescents: an investigation of the triple network model. Pain 2025; 166(2):338–46. [DOI] [PMC free article] [PubMed] [Google Scholar] - 18.Harris PA, Taylor R, Minor BL, et al. : The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95:103208. [DOI] [PMC free article] [PubMed] [Google Scholar] - 19.Harris PA, Taylor R, Thielke R, et al. : Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2):377–81. [DOI] [PMC free article] [PubMed] [Google Scholar] - 20.Castarlenas E, Jensen MP, von Baeyer C L, et al. : Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: a systematic review. Clin J Pain 2017; 33(4):376–83. [DOI] [PubMed] [Google Scholar] - 21.Dworkin RH, Turk DC, Farrar JT, et al. : Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005; 113(1–2):9–19. [DOI] [PubMed] [Google Scholar] - 22.Endicott J, Nee J, Harrison W: Daily record of severity of problems (DRSP): reliability and validity. Arch Womens Ment Health 2006; 9(1):41–9. [DOI] [PubMed] [Google Scholar] - 23.Scherrer KH, Ziadni MS, Kong JT, et al. : Development and validation of the collaborative health outcomes information registry body map. Pain Rep 2021; 6(1):e880. [DOI] [PMC free article] [PubMed] [Google Scholar] - 24.Bhandari RP, Feinstein AB, Huestis SE, et al. : Pediatric-collaborative health outcomes information registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain 2016; 157(9):2033–44. [DOI] [PMC free article] [PubMed] [Google Scholar] - 25.von Baeyer C L, Lin V, Seidman LC, et al. : Pain charts (body maps or manikins) in assessment of the location of pediatric pain. Pain Manag 2011; 1(1):61–8. [DOI] [PMC free article] [PubMed] [Google Scholar] - 26.Quinn H, Thissen D, Liu Y, et al. : Using item response theory to enrich and expand the PROMIS(R) pediatric self report banks. Health Qual Life Outcomes 2014; 12:160. [DOI] [PMC free article] [PubMed] [Google Scholar] - 27.Bevans KB, Meltzer LJ, La De, et al. : Qualitative development and content validation of the PROMIS pediatric sleep health items. Behav Sleep Med 2019; 17(5):657–71. [DOI] [PubMed] [Google Scholar] - 28.Forrest CB, Meltzer LJ, Marcus CL, et al. : Development and validation of the PROMIS pediatric sleep disturbance and sleep-related impairment item banks. Sleep. 2018; 41(6). [DOI] [PubMed] [Google Scholar] - 29.Dixon EA, Benham G, Sturgeon JA, et al. : Development of the sensory hypersensitivity scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli. J Behav Med 2016; 39(3):537–50. [DOI] [PMC free article] [PubMed] [Google Scholar] - 30.Walker LS, Beck JE, Garber J, et al. : Children’s Somatization Inventory: psychometric properties of the revised form (CSI-24). J Pediatr Psychol 2009; 34(4):430–40. [DOI] [PMC free article] [PubMed] [Google Scholar] - 31.Smith T, Kheirabadi D, Guo Y, et al. : Adverse childhood experiences and multisite pain among adolescents in the United States. Pain Rep 2025; 10(3):e1279. [DOI] [PMC free article] [PubMed] [Google Scholar] - 32.Foxen-Craft E, Bourchtein E, Kaplan C, et al. : Pain widespreadedness, and not primary Pain location, is associated with comorbid symptoms in children with chronic Pain. Clin J Pain 2023; 39(1):1–7. [DOI] [PubMed] [Google Scholar] - 33.Malattia C, Chiarella L, Sansone M, et al. : Sleep and Sleep complaints in juvenile fibromyalgia syndrome. J Rheumatol 2023; 50(6):827–34. [DOI] [PubMed] [Google Scholar] - 34.Senger-Carpenter T, Scott EL, Marriott DJ, et al. : Biopsychosocial attributes of single-region and multi-region body pain during early adolescence: analysis of the ABCD cohort. Clin J Pain 2022; 38(11):670–9. [DOI] [PMC free article] [PubMed] [Google Scholar] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article.