Highlights
- •Alterations in microstructure in provoked vestibulodynia (PVD) were observed.
- •Fibers associated with sensorimotor integration and pain processing were involved.
- •These alterations were associated with increased vaginal muscle tenderness and vulvar pain.
- •These alterations may contribute to increased pain sensitivity and tenderness.
- •These findings highlight the need for new therapies targeting the central nervous system.
Abstract
Provoked vestibulodynia (PVD) is a chronic pelvic pain disorder affecting 16% of the
female population. Neuroimaging studies have highlighted central abnormalities in
PVD, similar to other chronic pelvic pain disorders, including brain regions involved
in sensory processing and modulation of pain. The aim of the study was to determine
alterations in the subvoxel, microstructural organization within tissues in PVD compared
with healthy control participants (HCs) and a disease control group (irritable bowel
syndrome [IBS]). Diffusion tensor imaging magnetic resonance imaging was conducted
in 87 age-matched premenopausal women (29 PVD, 29 HCs, 29 IBS). Statistical parameter
mapping of fractional anisotropy (FA) and mean diffusivity (MD) maps were used to
identify microstructural difference in the brain specific to PVD or shared with IBS.
PVD alterations in microstructural organization of the brain were predominantly observed
in fibers associated with sensorimotor integration and pain processing that relay
information between the thalamus, basal ganglia, sensorimotor, and insular cortex.
PVD, compared with HCs, showed extensive increases in the FA of somatosensory and
basal ganglia regions. In contrast, PVD and IBS subjects did not show any FA-related
group differences. PVD subjects showed greater MD in the basal ganglia compared with
HCs (higher MD in the internal capsule and pallidum) and IBS (higher MD in the putamen
and pallidum). Increases in MD were associated with increased vaginal muscle tenderness
and vulvar pain. The current findings highlight possible shared mechanisms between
2 different pelvic pain disorders, but also highlight the widespread alterations observed
specifically in PVD compared with HCs.
Perspective
Alterations in microstructure in PVD were observed in fibers associated with sensorimotor
integration and pain processing, which were also associated with increased vaginal
muscle tenderness and vulvar pain. These alterations may be contributing to increased
pain sensitivity and tenderness, highlighting the need for new therapies targeting
the central nervous system.
Key words
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Article info
Publication history
Published online: February 03, 2018
Accepted:
December 17,
2017
Received in revised form:
November 6,
2017
Received:
July 28,
2017
Footnotes
Arpana Gupta and Davis C. Woodworth contributed equally to this work and share first authorship.
This work has been published, in part, as an abstract at the American Pain Society and the International Association of Pain Society annual conferences in 2016.
This research was supported in part by grants from the National Vulvodynia Association and National Institutes of Health: P30 DK041301, R01 DK048351, R01 HD076756, P50DK64539.
Pilot scans were provided by the Ahmanson-Lovelace Brain Mapping Center, UCLA.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2018 by the American Pain Society
