A Necessary Multi-Parametric Evaluation of Vulvodynia

外阴痛必要的多参数评估

• 批准号: 8534359
• 负责人: Richard H Gracely
• 金额: $ 35.06万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-24 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8534359
• 关键词: Affect; Algorithms; Area; Attention; Behavioral Mechanisms; C Fiber; Characteristics; Chronic; Chronic disabling pain; Classification; Clinical; Clinical Treatment; Clinical assessments; Cluster Analysis; Cognitive; Comorbidity; Complex; Cutaneous; Data; Diagnosis; Dimensions; Discriminant Analysis; Disease; Environmental Exposure; Evaluation; Fibromyalgia; Foundations; Frequencies; Genetic Predisposition to Disease; Goals; Individual; Inflammation; Injury; Intervention; Investigation; Knowledge; Laboratories; Lead; Location; Logistic Regressions; Low Back Pain; Machine Learning; Mediating; Methodology; Methods; Mucous Membrane; Muscle; Muscle Tension; Organ; Orofacial Pain; Pain; Pain Disorder; Pain Measurement; Pain management; Patients; Persistent pain; Phenotype; Physiological; Prevalence; Procedures; Process; Psychophysics; Publishing; Relative (related person); Research; Risk Factors; Sensory; Statistical Data Interpretation; Statistical Methods; Stimulus; Subgroup; Symptoms; Testing; Therapeutic; Variant; Vestibule; Vulva; Vulvodynia; Woman; Work; base; central sensitization; chronic pain; effective therapy; experience; neuromechanism; neurophysiology; novel; pressure; programs; psychologic; psychological distress; public health relevance; research clinical testing; research study; response; tool

DESCRIPTION (provided by applicant): Vulvodynia is a poorly understood and treated chronic pain disorder that affects an estimated 14 million women and is characterized by significant variation in location, temporal characteristics and clinical course. The contribution o multiple known and unknown components hinders adequate diagnosis and consequently rational choice of treatment. Identification and assessment of these underlying mechanisms would greatly advance the phenotyping of this prevalent disorder, which is a necessary step towards efficacious treatment. The proposed methods contain three necessary components. The first provides a systemic clinical exam of vulvar mucosa and muscle that is broadened greatly to include consideration of pain processes that are initiated by persistent pain. These include spinally-mediated C-fiber temporal summation, central sensitization and altered pain regulatory mechanisms that include decreased descending inhibition and increased descending facilitation. The methods will also evaluate a general pain amplification mechanism that has been observed in vulvodynia, fibromyalgia and low back pain, and that is likely distinct from spinally-mediated central sensitization. The second component recognizes the influence of psychological variables that determine distinct subgroups in other disorders and that can influence pain through physiological mechanisms ranging from increased muscle tension to increased sympathetic outflow. The proposal will use our previous experience and current results from a large-scale multi-center study (n=3500) and from an ongoing program project (n=1500) to evaluate important dimensions of psychological distress and cognitive style. The third component recognizes that adequate analysis of multiple evaluation procedures requires considerable knowledge and expertise in advance statistical methods. The research team includes a statistician, Dr. Eric Bair, who is especially knowledgeable about these types of analyses and experiences including the multi-center study and the program project cited above. The research team is particularly well prepared to conduct the proposed investigation because of significant experience and expertise in the proposed methods including clinical assessment and treatment of vulvodynia, psychophysical and neurophysiological assessment of pain and sensory function and sophisticated statistical analysis of data from pain assessments. The proposed work is supported by a significant amount of pertinent preliminary data that includes advanced clinical and psychophysical methodology.

描述（由申请人提供）：外阴痛是一种知名度不佳和治疗的慢性疼痛障碍，影响估计1400万妇女，其特征是位置，时间特征和临床过程的显着差异。 o多个已知和未知组件的贡献阻碍了足够的诊断，因此可以选择治疗。对这些基本机制的识别和评估将大大推动这种普遍疾病的表型，这是朝着有效治疗的必要步骤。 所提出的方法包含三个必要组件。第一个提供了对外阴粘膜和肌肉的系统性临床检查，该检查大大扩展，包括考虑持续疼痛引发的疼痛过程。其中包括旋转介导的C纤维时间求和，中央敏化和改变疼痛调节机制，包括降低降低抑制和降级促进。该方法还将评估一种普通的疼痛扩增机制，该机制已在外阴差，纤维肌痛和下背痛中观察到，这可能与旋转介导的中央敏化不同。 第二个成分认识到确定其他疾病中不同亚组的心理变量的影响，并且可以通过生理机制来影响疼痛，从增加肌肉张力到增加交感神经流出。该提案将利用我们以前的经验和当前的大规模多中心研究（n = 3500）以及正在进行的程序项目（n = 1500）的当前结果来评估心理困扰和认知风格的重要方面。 第三个组件认识到，对多个评估程序进行足够的分析需要提前统计方法的知识和专业知识。研究团队包括统计学家埃里克·贝尔（Eric Bair）博士，他特别了解这些类型的分析和经验，包括多中心研究和上述计划项目。 研究团队特别准备进行拟议的研究，因为在提议的方法中具有丰富的经验和专业知识，包括对外阴差的临床评估和治疗，对疼痛和感觉功能的心理物理和神经生理学评估，以及对疼痛评估的数据的复杂统计分析。拟议的工作得到了大量相关的初步数据的支持，包括先进的临床和心理物理方法。