Refining Diagnostic Criteria of a Pain Disorder: Vulvar Vestibulitis Syndrome

描述（由申请人提供）：外阴前庭炎综合征（VVS）是最常见的外阴-阴道慢性疼痛类型，在其生命的某个阶段对大约10%的女性的心理、身体和生殖健康产生负面影响。尽管经过数十年的研究，VVS的病因和病理生理仍不清楚。目前的治疗在很大程度上是经验性的，更多的是由临床医生的个人经验和舒适度来指导，而不是客观的治疗效果数据。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疾病。虽然被诊断为VVS的女性表现为一系列的粘膜敏感、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糙的粘膜敏感性测量（棉签触诊和患者疼痛报告）。缺乏严格的评估标准，并且依赖于临床医生和患者的高度主观的测量，这表明这种诊断目前很不明确。因此，它可能包括一个异质性的、潜在的不同群体的女性，她们唯一的共同特征是持续的外阴疼痛和性交困难。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，VVS的治疗干预措施的改进和对潜在病理生理的了解受到严重损害。我们的长期目标是了解VVS的发病机制，以便制定最佳的治疗策略。本提案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，以确定粘膜和骨盆肌肉疼痛敏感性的频谱（目的1-2）。我们还将评估中枢失调（通过实验性疼痛敏感性程序）和心理因素，为VVS作为一种真正的疼痛障碍的全面、多轴评估提供坚实的循证框架（目的3-4）。我们的基本原理是，VVS的治疗进展和预防潜力只有在VVS的综合多轴评估的概念框架背景下才能实现，类似于其他疼痛疾病（如颞下颌疾病，TMD）。这项研究的公共卫生意义在于，其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。

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.