Abnormal dynamic functional networks during pain-free periods: resting-state co-activation pattern analysis in primary dysmenorrhea

Chronic pain alters the configuration of brain functional networks. Primary dysmenorrhea (PDM) is a form of chronic visceral pain, which has been identified spatial alterations in brain functional networks using static functional connectivity analysis methods. However, the dynamics alterations of brain functional networks during pain-free periovulation phase remain unclear. Using the co-activation pattern (CAP) method, we investigated the dynamic network characteristics of brain functional networks and their relationship with pain-related emotions in a sample of 59 women with PDM and 57 demographically matched healthy controls (HCs) during the pain-free periovulation phase. We observed that patients with PDM showed significant alterations in brain dynamics compared to HCs in the slow-4 (0.027-0.073 Hz) frequency band during the pain-free periovulation phase. Additionally, the fraction of time for CAP state 2 was positively correlated with the Pain Catastrophizing Scale-helplessness score, while the persistence time for CAP state 1 was positively correlated with the McGill Pain Questionnaire score. Our results provide new insights, suggesting that the atypical brain functional network dynamics may serve as a potential biological marker of patients with PDM during the pain-free periovulation phase.