Purpose: Dysmenorrhea (DM), which involves both acute and chronic pain, is associated with abnormalities in pain modulation. Previous studies have shown that social pain relies on some of the same neural regions that process physical pain, highlighting a possible physical–social pain overlap. However, evidence suggesting that social pain modulates the sensitivity to physical pain remains controversial. The present study aimed to assess the effects of social pain manipulation on sensitivity to physical pain in DM sufferers and healthy female controls (HC).
Materials and methods: Fifty-nine otherwise healthy patients with DM and 55 HC matched for age, education, calendar age, and gynecological age were randomly assigned to inclusion or exclusion conditions of Cyberball, a virtual ball tossing game used to induce social pain (social exclusion). Pain threshold and pain tolerance in response to nociceptive pressure and cold stimuli were assessed before and after the study condition.
Results: In response to cold stimulation, pain threshold and tolerance significantly reduced in DM compared to HC participants in the inclusion condition, indicating increased pain sensitivity in DM group. However, exclusion increased the pain threshold and tolerance compared to inclusion in DM but decreased pain threshold and tolerance in HC. Neither inclusion nor exclusion altered pressure pain sensitivity in DM, but, after social exclusion, DM participants were more fearful of being evaluated unfavorably. No significant differences were observed in self-esteem scores between DM and HC after both inclusion and exclusion. 
Conclusion: We observed altered pain sensation in DM participants in response to social pain manipulation, suggesting that DM not only impacts menstruation but also modulates the perception of pain more generally, especially its affective processes. The present study suggests that the effect of social pain on pain sensation and certain psychometric properties depends on previous pain experience, implicating a reciprocal influence of social and physical pain processes.
Keywords: dysmenorrhea, Cyberball, pain modulation, pain sensitivity, physical pain, social pain, social exclusion