A Necessary Multi-Parametric Evaluation of Vulvodynia

外阴痛必要的多参数评估

• 批准号: 9097408
• 负责人: Richard H Gracely
• 金额: $ 36.04万
• 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/9097408
• 关键词: Affect; Algorithms; Area; Assessment tool; 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; Health; Individual; Inflammation; Injury; Intervention; Investigation; Knowledge; Laboratories; Lead; Location; Logistic Regressions; Low Back Pain; Machine Learning; Mediating; Methodology; Methods; Mucous Membrane; Multicenter Studies; Muscle; Muscle Tension; Organ; Orofacial Pain; Pain; Pain Disorder; Pain Measurement; Pain management; Patients; Persistent pain; Phenotype; Physiological; Prevalence; Procedures; Process; Psychophysics; Publishing; 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; individual patient; learning strategy; neuromechanism; neurophysiology; novel; pain symptom; pressure; programs; psychologic; psychological distress; research clinical testing; research study; response; tool; treatment choice

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）：外阴痛是一种人们对它知之甚少、治疗方法也很少的慢性疼痛疾病，影响了估计 1400 万女性，其特点是位置、时间特征和临床病程的显着差异。多种已知和未知成分的影响阻碍了充分的诊断以及合理的治疗选择。对这些潜在机制的识别和评估将极大地推进这种普遍疾病的表型分析，这是实现有效治疗的必要步骤。 所提出的方法包含三个必要的组成部分。第一个提供了外阴粘膜和肌肉的系统临床检查，其范围大大扩大，包括考虑由持续性疼痛引发的疼痛过程。这些包括脊髓介导的 C 纤维时间总和、中枢敏化和改变的疼痛调节机制，包括减少下行抑制和增加下行促进。这些方法还将评估在外阴痛、纤维肌痛和腰痛中观察到的一般疼痛放大机制，这可能与脊髓介导的中枢敏化不同。 第二个组成部分认识到心理变量的影响，这些变量决定其他疾病的不同亚组，并且可以通过从肌肉紧张增加到交感神经流出增加等生理机制影响疼痛。该提案将利用我们之前的经验以及大规模多中心研究 (n=3500) 和正在进行的项目 (n=1500) 的当前结果来评估心理困扰和认知风格的重要维度。 第三个组成部分认识到，对多种评估程序的充分分析需要先进统计方法方面的大量知识和专业知识。研究团队包括一名统计学家 Eric Bair 博士，他对这些类型的分析和经验特别了解，包括上述多中心研究和项目项目。 研究小组为开展拟议的调查做好了充分的准备，因为他们在拟议方法方面拥有丰富的经验和专业知识，包括外阴痛的临床评估和治疗、疼痛和感觉功能的心理物理学和神经生理学评估以及疼痛评估数据的复杂统计分析。拟议的工作得到了大量相关初步数据的支持，其中包括先进的临床和心理物理学方法。

项目成果

Vibrotactile discriminative capacity is impacted in a digit-specific manner with concurrent unattended hand stimulation.

振动触觉辨别能力以特定于数字的方式受到同时无人看管的手部刺激的影响。

• 发表时间: 2014-11
• 影响因子: 2
• 作者: Nguyen, Richard H;Forshey, Theresa M;Holden, Jameson K;Francisco, Eric M;Kirsch, Bryan;Favorov, Oleg;Tommerdahl, Mark
• 通讯作者: Tommerdahl, Mark