Women’s Health

Posted on Fibromyalgia, Pain Management, Women's Health

Researchers explore new methods for quantifying chronic pain in women

Measuring pain

Over 70% of chronic pain cases are women. Effective treatment of pain has been hampered by an entirely subjective protocol for measuring pain severity, with variation introduced in patient assessments and physician biases. Credit Arocamora, CC BY-SA 4.0

Chronic pain affects millions of people, with women experiencing more severe and frequent pain than men. Over 70% of chronic pain cases involve women. However, measuring and managing pain remains a complex challenge. There is currently no objective method to quantify pain, which makes it difficult to tailor treatments effectively. Additionally, there are significant variations in how patients experience pain and how physicians respond. A new research initiative aims to address these issues.

Tufts University, in collaboration with external partners, has been selected by the Advanced Research Projects Agency for Health (ARPA-H) as an award recipient for the Sprint for Women’s Health. This initiative aims to develop new technologies for quantitatively measuring pain in patients, to improve care and accelerate the development of new treatments. The team will receive $3.03 million in funding over the next two years.

Various factors, such as inflammation, damaged nerves, or conditions like fibromyalgia, can cause chronic pain. Each of these causes may require a different treatment approach. Regardless of its origin, pain is highly subjective and can be influenced by psychological, social, and other factors. While elite athletes and soldiers often train to tolerate high levels of pain, individual reactions to pain can vary significantly among those who experience it.

Standard practice in assessing pain in the clinical setting is entirely subjective—something most of us have experienced if asked to measure it on a chart using smiling to frowning emoticons.

Subjectivity in assessing pain is not just on the patient’s side. Bias also occurs on the treatment side, with some minority groups being undertreated for managing pain compared to the general population.

“Having an objective, quantitative tool to assess pain will help eliminate subjective variables and provide a more rational basis for treatment,” said Sameer Sonkusale, a professor of electrical and computer engineering at the Tufts School of Engineering and the principal investigator on the project. The project includes collaborators from the Uniformed Services University of Health Sciences (USU), The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), and Northwestern Medicine.

The research team plans to screen more than 30 biomarkers, including stress hormones, inflammation markers, and neurotransmitters in the interstitial fluid that circulates between skin cells. Additionally, they will monitor physiological responses such as fluctuations in heart rate, galvanic skin response, and breathing patterns.

These biomarkers were identified in earlier studies as linked to a patient’s experience of pain, but this is the first effort to create a composite panel of markers to generate a quantitative score for pain.

The biomarker data will be merged with answers to pain questionnaires collected from women at several sites, including the Defense and Veterans Center for Integrative Pain Management and Northwestern Medicine. Shuchin Aeron, an electrical and computer engineering associate professor at Tufts, will apply artificial intelligence and machine learning to combine these factors into an objective and quantitative pain score.

The researchers will narrow the panel to five or more of the most reliable pain-linked biomarkers. These biomarkers can be monitored on a portable, wearable device for clinical site and remote pain assessment. The results would instantly be reported to the physician or the patient on a smartwatch or ring.

The availability of such devices would not only improve pain management. Still, it could also accelerate the development of new drugs and treatments, which could benefit from an objective measure of their effectiveness.

“While pain reporting is subjective and dependent on many extraneous factors, for the same pain level, the measurable physiological markers and signals are expected to be similar from one individual to the next,” said Sonkusale. “Considering an observed gender bias in the prevalence and approach to treatment of chronic pain, this technology addresses a large unmet medical need for women, creating a path to more effective pain management.”

“It has been extremely challenging to objectively quantify nociplastic pain—the type of pain involving nervous system sensitization in conditions like fibromyalgia that are quite common in women. This study could provide a way to objectively quantify pain in a way that will greatly help their treatment,” said Steven P Cohen, Edmond I Eger Professor of Anesthesiology and Pain Medicine at Northwestern Medicine.

Posted on ADHD, Mental health, Women's Health

Significant impact of partners’ ADHD on women’s mental health and quality of life new study reveals

Is it ADHD - click here to find out!

A new study brings attention to the often-overlooked challenges faced by women in relationships with partners diagnosed with ADHD. The research reveals that the partners’ ADHD symptoms are associated with higher rates of depression and lower quality of life in women. However, women who engage in health-promoting activities experience fewer depressive symptoms and improved well-being. The findings suggest that ADHD treatment should not only focus on the individual with ADHD but also consider the well-being of their partners, offering new opportunities for supportive interventions. Further research is needed to explore the long-term effects and develop targeted solutions.

A recent study by researchers Dana Zeides Taubin, Haya Fogel-Grinvald, and Prof. Adina Maeir from the School of Occupational Therapy at Hebrew University brings attention to the often overlooked experiences of women in relationships with partners diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The research investigates the link between partners’ ADHD symptoms and women’s mental health and quality of life, providing valuable insights for both clinicians and couples.

The study’s results show that:

  • Women partnered with individuals diagnosed with ADHD may face an increased risk of depressive symptoms and reduced quality of life.
  • Partners with ADHD who have more difficulties in daily functioning are linked to higher levels of depression in women and a lower quality of life for them.
  • Engagement in health-promoting activities (HPA) by women is positively linked to their quality of life and negatively associated with depressive symptoms.
  • Women partnered with individuals diagnosed with ADHD may face an increased risk of depressive symptoms and reduced quality of life.
  • Partners with ADHD who have more difficulties in daily functioning are linked to higher levels of depression in women and a lower quality of life for them.
  • Engagement in health-promoting activities (HPA) by women is positively linked to their quality of life and negatively associated with depressive symptoms.

This research has important implications for clinical practice and emphasizes the need for a more comprehensive approach to treating adult ADHD. Clinicians are encouraged to take into account not only the individual diagnosed with ADHD but also the experiences and well-being of their partners.

The study suggests that integrating health-promoting activities into therapeutic approaches may benefit partners of individuals with ADHD. This discovery creates new opportunities for developing tailored supportive interventions for this often overlooked group.

Posted on Multiple Sclerosis, Women's Health

New study uncovers therapeutic inertia in the treatment of women with multiple sclerosis

A study has revealed significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), highlighting gender disparities that could impact long-term health outcomes for women of childbearing age.
A study has revealed significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), highlighting gender disparities that could impact long-term health outcomes for women of childbearing age.

The findings suggest that concerns related to pregnancy may result in delayed or reduced use of disease-modifying treatments (DMTs), even before pregnancy is considered.

The study also found that the difference in treatment became apparent after two years of disease duration for DMTs and as early as one year for HEDMTs. Notably, this gender-based treatment gap did not significantly change with patient age, suggesting that therapeutic inertia could persist regardless of the woman’s stage in life.

“These findings emphasize the crucial need to reconsider how we make treatment decisions for women with MS, especially those of childbearing age,” says Professor Sandra Vukusic, the lead author of the study. “Women may not be receiving the most effective therapies at the optimal time, often due to concerns about pregnancy risks that may never materialize. The use of Disease-Modifying Therapies (DMTs) and Highly Effective Disease-Modifying Therapies (HEDMTs) is frequently limited by potential and unknown risks associated with pregnancy, as there is often insufficient data available when these drugs first come to market.”

Both neurologists and patients contribute to therapeutic inertia, with many adopting a cautious approach and avoiding these treatments. “Neurologists may be reluctant to prescribe DMTs, especially if they are not comfortable managing pregnancy-related issues,” explains Professor Vukusic. “At the same time, women understandably do not want to take any risks for their child or pregnancy. Their primary concerns are congenital malformations, fetal loss, and fetal growth disorders. Women will also feel uncomfortable if their neurologist appears uncertain.”

Moving forward, the research team plans to further investigate the factors contributing to therapeutic inertia. They aim to improve treatment strategies prioritizing the long-term health of women with MS and their reproductive goals.

“The main impact of this inertia is the less effective control of disease activity during DMT-free periods, leading to the accumulation of lesions and an increased risk of long-term disability,” emphasizes Professor Vukusic. “This represents a real loss of opportunity for women, especially in an era where DMTs are so effective when used early.”

Posted on Autism, Women's Health

Warning signs: Data indicates that autistic mothers are at higher risk for postpartum anxiety and depression.

New guidelines for pregnancy in multiple sclerosis
New research from the Policy and Analytics Center at Drexel University’s A.J. Drexel Autism Institute looked into perinatal and postpartum outcomes among individuals with intellectual and developmental disabilities.

American women have the highest rate of maternal deaths among high-income countries, with outcomes worse for minoritized groups. In a recent study published in JAMA Network Open, researchers from Drexel University’s Policy and Analytics Center in the A.J. Drexel Autism Institute examined Medicaid data to better understand and identify perinatal and postpartum outcomes among people with intellectual and developmental disabilities, including autism and intellectual disability. 

Lindsay Shea, DrPH, director of the Policy and Analytics Center in the A.J. Drexel Autism Institute and lead author of the study, highlighted that while previous studies have reported an increased risk for challenges related to pregnancy and birth among people with intellectual and developmental disabilities, little research has been done using United States-based population-level data. Medicaid, as it covers almost half of births in the U.S. and a disproportionate share of people with intellectual and developmental disabilities, is a key system to study these risks and opportunities for policy and program improvements. The study revealed that people with intellectual and developmental disabilities were younger at the time of their first delivery and had higher risks for multiple medical and mental health conditions, such as gestational diabetes, gestational hypertension, and preeclampsia. Autistic pregnant individuals had a significantly higher probability of experiencing postpartum anxiety and postpartum depression compared to people with intellectual disabilities only and those without intellectual and developmental disabilities.

Researchers examined national Medicaid claims to compare perinatal and postpartum outcomes across groups of birthing people with intellectual and developmental disabilities (including intellectual disability and autism) and a random sample of birthing people without intellectual and developmental disabilities. The data included Medicaid claims from 2008-2019 for 55,440 birthing people with intellectual and developmental disabilities and a random sample of 438,557 birthing people without intellectual and developmental disabilities.

The study compared perinatal outcomes, including medical conditions like gestational diabetes, gestational hypertension, and preeclampsia, as well as mental health conditions such as anxiety disorders and depressive disorders, across different groups. Researchers used Kaplan-Meier and Cox proportional hazard regressions to estimate the likelihood of postpartum anxiety and postpartum depression.Co-author Molly Sadowsky, project director at the Policy and Analytics Center in the Autism Institute, explained that the findings suggest several opportunities for policymakers, providers, and researchers. It is important to tailor reproductive health education, perinatal care, and delivery services to provide comprehensive and targeted support for birthing individuals with intellectual and developmental disabilities. Policies should be designed and implemented to meet the needs of people with intellectual and developmental disabilities, with the goal of reducing maternal health disparities. Clinical guidelines and procedures should be adjusted to accommodate the specific needs and experiences of people with intellectual and developmental disabilities. Additionally, new Medicaid policies, such as the postpartum coverage extension and doula service reimbursement, should be evaluated for their impact on the health outcomes of people with intellectual and developmental disabilities.

“The findings of this study emphasize the urgent need for Medicaid to support birthing individuals with intellectual and developmental disabilities during the perinatal period,” said Sadowsky. “It’s crucial to address differences in access to postpartum care and coordination, as well as the related disparities in the risk of postpartum depression and anxiety.”Shea and Sadowsky also explained their plans for future work, stating, “In our next project, we will further this research by examining the impact of attitudinal and structural ableism on perinatal health and mental health outcomes, as well as on neonatal and postnatal outcomes, morbidity, and mortality among children of women with and without intellectual and developmental disabilities,” said Shea.

Shea and her research team have been granted a five-year, $3 million National Institutes of Health Research Project Grant (R01) to further investigate the impact of ableism on women with intellectual and developmental disabilities during pregnancy and the postpartum period. The upcoming study will involve a detailed examination and comparison of outcomes experienced by this group and their infants to those of peers without intellectual and developmental disabilities. Shea expressed her enthusiasm about the future of their work in this area, emphasizing the importance of supporting individuals and celebrating their birthing experiences and roles during these significant times in life.
Posted on Autism, Women's Health

Autistic Menopause & Ageing with Christine Jenkins

How often do you hear or read about older autistic adults and our ageing process? Not frequently, I bet. Thanks to Christine Jenkins and the Autistic Menopause research team, not only is autistic ageing coming to the forefront, but so is menopause. Finally! There are so many of us who have been privately discussing where we are in this season of our lives, going through perimenopause, and how it impacts our sensory systems and even our experience of burnout.