Refining Diagnostic Criteria of a Pain Disorder: Vulvar Vestibulitis Syndrome

完善疼痛疾病的诊断标准：外阴前庭炎综合征

• 批准号: 7135392
• 负责人: DENNIZ A ZOLNOUN
• 金额: $ 13.08万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-20 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7135392
• 关键词: clinical research; diagnosis design /evaluation; disease /disorder etiology; female; gynecology; hormone regulation /control mechanism; human subject; interview; longitudinal human study; medical outreach /case finding; pain; pathologic process; psychometrics; questionnaires; vagina disorder; women' s health

DESCRIPTION (provided by applicant): Vulvar Vestibulitis Syndrome (VVS), the most common type of chronic vulvo-vaginal pain, negatively impacts the psychological, physical, and reproductive health of approximately 10% of women at some point in their life. Despite decades of research, the etiology and pathophysiology of VVS remain unknown. Current treatments are largely empiric and guided more by an individual clinician's prior experience and comfort level than objective data on therapeutic efficacy. Recent evidence suggests that the etiology of VVS involves impairment of biological and psychological processes, similar to those of other chronic pain disorders. Although women diagnosed with VVS present with a spectrum of mucosal sensitivity, pelvic muscle dysfunction, and psychological distress, the actual diagnosis of VVS continues to rely on relatively crude measures of mucosal sensitivity (cotton swab palpation and patient report of pain) on clinical exam. A lack of strict criteria for evaluation, and dependence on highly subjective measures by both clinician and patient, suggests that this diagnosis is currently poorly circumscribed. As such, it is likely to encompass a heterogeneous, potentially divergent group of women with the sole common feature of frustration with persistent vulvar pain and dyspareunia. Refinement of therapeutic interventions and insight into the underlying pathophysiology of VVS are critically impaired by lack of methods to reliably and reproducibly assess key features of VVS, as well as by the lack of a classification system based on pathophysiological processes. Our long-term goal is to understand the pathogenesis of VVS, so that optimal treatment strategies can be developed. The primary goal of this proposal is to establish the reliability and reproducibility of our recently developed quantitative assessment tools to determine the spectrum of mucosal and pelvic muscle pain sensitivity (Aims 1-2). We will also assess central dysregulation (via experimental pain sensitivity procedures) and psychological factors to provide a solid evidence-based framework for a comprehensive, multiaxial assessment of VVS as a true pain disorder (Aims 3-4). Our rationale is that advances in treatment and potential for prevention of VVS can only be realized in the context of a conceptual framework informed by comprehensive multiaxial assessment of VVS, similar to that of other pain disorders (e.g., temporomandibular disorder, TMD). The public health relevance of this research is that its successful completion will positively impact the physical, psychological and reproductive health of millions of women.

描述(由申请人提供)：外阴前庭综合征(VVS)是最常见的慢性外阴-阴道疼痛类型，在她们生命中的某个阶段对大约10%的女性的心理、身体和生殖健康产生负面影响。尽管经过了几十年的研究，但VVS的病因和病理生理学仍不清楚。目前的治疗在很大程度上是经验性的，更多地是由个别临床医生的先前经验和舒适度指导的，而不是关于治疗效果的客观数据。最近的证据表明，VVS的病因涉及生物和心理过程的损害，类似于其他慢性疼痛障碍。尽管被诊断为VVS的女性表现出一系列的粘膜敏感性、盆腔肌功能障碍和心理困扰，但VVS的实际诊断仍然依赖于临床检查中相对粗略的粘膜敏感性测量(棉签触诊和患者疼痛报告)。缺乏严格的评估标准，以及临床医生和患者对高度主观测量的依赖，表明目前这种诊断的界限很差。因此，它可能包括一个不同的，潜在的不同的女性群体，唯一的共同特征是对持续的外阴疼痛和性交困难感到沮丧。由于缺乏可靠和可重复地评估VVS关键特征的方法，以及缺乏基于病理生理过程的分类系统，对VVS治疗干预措施的改进和对VVS潜在病理生理学的洞察严重受损。我们的长期目标是了解VVS的发病机制，以便开发出最佳的治疗策略。这项建议的主要目标是建立我们最近开发的定量评估工具的可靠性和可重复性，以确定黏膜和盆腔肌肉疼痛敏感性的频谱(目标1-2)。我们还将评估中枢失调(通过实验性疼痛敏感程序)和心理因素，以提供一个坚实的循证框架，为将VVS作为一种真正的疼痛障碍进行全面、多轴的评估提供一个坚实的循证框架(目标3-4)。我们的基本原理是，VVS的治疗进展和预防潜力只能在VVS的综合多轴评估的概念框架的背景下实现，类似于其他疼痛障碍(例如，TMD)。这项研究的公共卫生意义在于，它的成功完成将对数百万妇女的身体、心理和生殖健康产生积极影响。