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）是最常见的慢性外阴阴道疼痛类型，对大约10%的女性在其生命中的某个阶段的心理，身体和生殖健康产生负面影响。尽管经过数十年的研究，VVS的病因和病理生理学仍然未知。目前的治疗主要是经验性的，更多地由个别临床医生的先前经验和舒适度水平而不是关于治疗效果的客观数据来指导。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。虽然诊断为VVS的女性表现为一系列的粘膜敏感性、盆腔肌肉功能障碍和心理困扰，但VVS的实际诊断仍然依赖于相对粗糙的粘膜敏感性测量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测量，表明这种诊断目前还没有得到很好的限制。因此，它可能包括一个异质的，潜在的分歧组的妇女与唯一的共同特点的挫折与持续外阴疼痛和性交困难。由于缺乏可靠和可重复评估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，治疗干预措施的完善和对VVS潜在病理生理学的深入了解受到严重损害。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。该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，为全面、多轴评估VVS作为真正的疼痛障碍提供坚实的循证框架（目标3 - 4）。我们的理论基础是，只有在通过对VVS进行全面多轴评估的概念框架的背景下，才能实现VVS治疗和预防潜力的进步，类似于其他疼痛疾病（例如，颞下颌关节紊乱病，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。

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.