Basha ME, Kellogg-Spadt S, Burrows LJ, Ruberu MS, Wallach AS, Nazar AM, Whitmore KE. Thermal and Mechanical Pain Thresholds of Women With Provoked Localized Vulvodynia: A Pilot Study. J Am Osteopath Assoc 2019;119(3):164–172. doi: https://doi.org/10.7556/jaoa.2019.027.
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Vulvodynia is a chronic pain condition defined as vulvar pain lasting at least 3 months in the absence of gross anatomic or neurologic findings. Provoked, localized vulvodynia (PLV), a subtype of vulvodynia, is characterized by vestibular pain in response to light touch. The cause of PLV remains largely unknown, and triggering events have yet to be determined.
To evaluate vestibular and peripheral experimental pain thresholds in patients with PLV to further define the somatosensory profile of these patients.
After informed consent was provided, eligible participants completed a questionnaire and underwent quantitative sensory testing at the forearm and posterior vestibule. Detection and pain thresholds to thermal (cold and heat) and mechanical (pressure) stimuli were measured.
Seventeen participants with PLV and 16 control participants were included. Participants in the PLV group scored lower on the patient health questionnaire 9 (PHQ-9) compared with those in the control group (P<.05) and had higher ratings of self-reported genital pain with sex (P<.001) and daily activity (P<.05). Forearm pain thresholds to cold (P<.01) and heat (P<.01) stimuli were also lower in the PLV group compared with those in the control group. Vestibular pain thresholds to cold (P<.05) and pressure (P<.01) stimuli were also lower in the PLV group.
Lower scores on the PHQ-9 and higher self-reported genital pain ratings of patients with PLV highlight the significant impact of this poorly understood condition on quality of life. Quantitative sensory testing results demonstrated that vestibular cold allodynia may be a somatosensory feature of PLV. Reduced forearm pain thresholds in these patients suggest altered sensory processing at extrapelvic sites, although it is unclear whether these measurements are related to central sensitization.
Abbreviations: BMI, body mass index; IBS, irritable bowel syndrome; PBS/IC, painful bladder syndrome/interstitial cystitis; PLV, provoked localized vulvodynia; VAS, visual analogue scale.
a Pain was rated on a scale of 0 (no pain) to 10 (worst imaginable pain).
Abbreviations: PLV, provoked localized vulvodynia; PV, posterior vestibule.
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