Neurophysiological and Psychological Correlates of Vulvodynia

描述(由申请人提供)：外阴疼痛是一种多方面的、慢性的女性泌尿生殖系统疼痛综合征，尚未得到充分的研究，它给女性及其家庭、医疗保健系统和社会带来了巨大的心理和经济负担。与其他慢性疼痛综合征类似，外阴疼痛症状的发展和维持很可能是生物和心理因素的复杂组合；然而，这些机制尚未得到很好的描述或了解，有效的治疗仍然难以实现。加深对这些因素各自作用的了解将提供有关外阴疼痛的关键信息，并为开发基于机械的干预措施提供关键的第一步。近年来，研究表明，外阴疼痛的潜在机制可能因外阴疼痛的不同临床表现而有所不同。因此，这项描述性研究的目的是彻底阐明与外阴疼痛相关的生理和心理因素，并与没有外阴疼痛的女性进行比较，并检验以下假设：这些机制在具有不同发病模式的女性中不同，特别是原发性外阴疼痛(即一直经历外阴疼痛)和继发性外阴疼痛(即在无痛时期后出现疼痛)。首先，申请者将使用一系列全面的定量感觉测试(QST)方法评估20名患有原发性外阴疼痛的女性、20名患有继发性外阴疼痛的女性以及20名年龄和种族匹配的非外阴疼痛女性的神经感觉处理。培训的重点将是增加神经生理学知识和学习疼痛研究的实验方法。其次，申请者将使用自我报告的疼痛恐惧和灾难(即对预期或实际疼痛的负面认知-情感反应)测量来评估三组妇女的心理因素。培训将侧重于学习方法，以准确评估慢性外阴疼痛人群中的这些心理因素。在慢性疼痛的神经感觉处理的实验研究和泌尿生殖系统疼痛障碍的神经生物学方面具有专业知识的资深导师团队将在拟议的研究项目和整个博士培训期间指导申请者。拟议的研究很好地符合NINR的使命，即检查与疾病相关的症状(例如，疼痛)的潜在生物学机制。最终，这项研究的结果将为我们提供关于外阴疼痛的知识，并将为未来的研究提供方向，为外阴疼痛的治疗开发新的靶向疗法。

DESCRIPTION (provided by applicant): Vulvodynia is a multifaceted, chronic, female urogenital pain syndrome that is understudied and carries a substantial psychological and economic burden for women and their families, the healthcare system, and society. Similar to other chronic pain syndromes, the development and maintenance of vulvodynia symptomatology is most likely a complex combination of biological and psychological factors; however, these mechanisms are not well-described or understood and effective treatment remains elusive. An increased understanding of the respective contribution of each of these elements will impart critical information about vulvodynia and provide the crucial first steps for the development of mechanistic-based interventions. In recent years, studies have suggested the underlying mechanisms may vary amongst the multifarious clinical presentations of vulvodynia. Therefore, the purpose of this descriptive study is to thoroughly elucidate the physiological and psychological factors associated with vulvodynia in comparison to women without and test the hypothesis that these mechanisms differ in women with distinct patterns of disease onset, specifically primary (i.e., has always experienced vulvar pain) and secondary (i.e., development of pain following a pain free period) vulvodynia. First, the applicant will assess the neurosensory processing using a comprehensive battery of quantitative sensory testing (QST) methods in 20 women with primary vulvodynia, 20 women with secondary vulvodynia, and 20 age and race matched women without vulvodynia. Training will focus on increasing knowledge in neurophysiology and learning experimental methods in pain research. Second, the applicant will assess psychological factors using self-report measures of fear of pain and catastrophizing (i.e., negative cognitive-affective response to anticipated or actual pain) in the three groups of women. Training will focus on learning methods to accurately assess these psychological factors in a chronic vulvar pain population. A team of senior mentors with expertise in the experimental investigation of neurosensory processing of chronic pain and the neurobiology of urogenital pain disorders will guide the applicant in the proposed research project and throughout her doctoral training. The proposed research aligns well with the NINR's mission to examine the underlying biological mechanisms of symptoms (e.g., pain) associated with disease. Ultimately, findings from this study will inform our knowledge about vulvodynia and will provide direction for future research with regard to development of novel targeted therapies for treatment of vulvodynia.