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1. Brain responses to vestibular pain and its anticipation in women with Genito-Pelvic Pain/Penetration Disorder

Author

Els Pazmany, Huynh Giao Ly, Leen Aerts, Michiko Kano, Sophie Bergeron, Johan Verhaeghe, Ronald Peeters, Jan Tack, Patrick Dupont, Paul Enzlin, and Lukas Van Oudenhove

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Neurology. Diseases of the nervous system, RC346-429
Abstract

Objective: In DSM-5, pain-related fear during anticipation of vaginal penetration is a diagnostic criterion of Genito-Pelvic Pain/Penetration Disorder (GPPPD). We aimed to investigate subjective and brain responses during anticipatory fear and subsequent induction of vestibular pain in women with GPPPD. Methods: Women with GPPPD (n=18) and age-matched healthy controls (HC) (n=15) underwent fMRI scanning during vestibular pain induction at individually titrated pain threshold after a cued anticipation period. (Pain-related) fear and anxiety traits were measured with questionnaires prior to scanning, and anticipatory fear and pain intensity were rated during scanning using visual analog scales. Results: Women with GPPPD reported significantly higher levels of anticipatory fear and pain intensity. During anticipation and pain induction they had stronger and more extensive brain responses in regions involved in cognitive and affective aspects of pain perception, but the group difference did not reach significance for the anticipation condition. Pain-related fear and anxiety traits as well as anticipatory fear ratings were positively associated with pain ratings in GPPPD, but not in HC. Further, in HC, a negative association was found between anticipatory fear ratings and brain responses in regions involved in cognitive and affective aspects of pain perception, but not in women with GPPPD. Conclusions: Women with GPPPD are characterized by increased subjective and brain responses to vestibular pain and, to a lesser extent, its anticipation, with fear and anxiety associated with responses to pain, supporting the introduction of anticipatory fear as a criterion of GPPPD in DSM-5. Keywords: Anticipation of pain, Pain-related fear and anxiety, Vestibular pain, fMRI, Genito-pelvic pain/penetration disorder, Provoked vestibulodynia

Published
2017
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2. Brain responses to vestibular pain and its anticipation in women with Genito-Pelvic Pain/Penetration Disorder

Author

Ronald Peeters, Patrick Dupont, Els Pazmany, Sophie Bergeron, Johan Verhaeghe, Lukas Van Oudenhove, Jan Tack, Paul Enzlin, Leen Aerts, Michiko Kano, and Huynh Giao Ly

Subjects
0301 basic medicine, NEURAL CIRCUITRY, FM, fibromyalgia, IRRITABLE-BOWEL-SYNDROME, Vulvodynia, FEAR, Q1, Quartile 1, Provoked vestibulodynia, lcsh:RC346-429, VAS, Visual Analogue Scale, 0302 clinical medicine, STAI, State-Trait Anxiety Inventory, dlPFC, dorsolateral prefrontal cortex, ANXIETY, Anticipation of pain, Sexual Dysfunctions, Psychological, HC, healthy controls, PASS, Pain Anxiety Symptoms Scale, Vestibular system, medicine.diagnostic_test, vlPFC, ventrolateral prefrontal cortex, SMA, supplementary motor area, fMRI, Brain, Regular Article, Pain Perception, DSM-5, Diagnostic Statistical Manual of Mental Disorders, fifth edition, GPPPD, Genito-Pelvic Pain/Penetration Disorder, Anticipation, Anxiety Disorders, Magnetic Resonance Imaging, SPSS, Statistical Package for Social Sciences, Vestibular pain, Neurology, fMRI, functional magnetic resonance imaging, Anesthesia, Q3, Quartile 3, lcsh:R858-859.7, Vaginal penetration, Female, medicine.symptom, VISCERAL PAIN, Psychology, Life Sciences & Biomedicine, medicine.medical_specialty, SEX-DIFFERENCES, IBS, irritable bowel syndrome, Adolescent, Pain-related fear and anxiety, Cognitive Neuroscience, ACTIVITY PREDICTS, HEALTHY CONTROLS, Neuroimaging, vmPFC, ventromedial prefrontal cortex, TR/TE, repetition time/echo time, lcsh:Computer applications to medicine. Medical informatics, Pelvic Pain, DSM-5, 03 medical and health sciences, OFC, orbitofrontal cortex, Physical medicine and rehabilitation, medicine, PVD, provoked vestibulodynia, Humans, Radiology, Nuclear Medicine and imaging, pACC, perigenual anterior cingulate cortex, Genito-pelvic pain penetration disorder, lcsh:Neurology. Diseases of the nervous system, aMCC, anterior midcingulate cortex, PERCEPTION, Science & Technology, FPQ, Fear of Pain Questionnaire, Pelvic pain, SAS, statistical analysis software, SPM8, Statistical Parametric Mapping, SPM8, Magnetic resonance imaging, medicine.disease, Anticipation, Psychological, n, number, 030104 developmental biology, VULVAR VESTIBULITIS, Genito-pelvic pain/penetration disorder, SII, secondary somatosensory cortex, Neurology (clinical), Neurosciences & Neurology, SD, standard deviation, 030217 neurology & neurosurgery
Abstract

Objective In DSM-5, pain-related fear during anticipation of vaginal penetration is a diagnostic criterion of Genito-Pelvic Pain/Penetration Disorder (GPPPD). We aimed to investigate subjective and brain responses during anticipatory fear and subsequent induction of vestibular pain in women with GPPPD. Methods Women with GPPPD (n = 18) and age-matched healthy controls (HC) (n = 15) underwent fMRI scanning during vestibular pain induction at individually titrated pain threshold after a cued anticipation period. (Pain-related) fear and anxiety traits were measured with questionnaires prior to scanning, and anticipatory fear and pain intensity were rated during scanning using visual analog scales. Results Women with GPPPD reported significantly higher levels of anticipatory fear and pain intensity. During anticipation and pain induction they had stronger and more extensive brain responses in regions involved in cognitive and affective aspects of pain perception, but the group difference did not reach significance for the anticipation condition. Pain-related fear and anxiety traits as well as anticipatory fear ratings were positively associated with pain ratings in GPPPD, but not in HC. Further, in HC, a negative association was found between anticipatory fear ratings and brain responses in regions involved in cognitive and affective aspects of pain perception, but not in women with GPPPD. Conclusions Women with GPPPD are characterized by increased subjective and brain responses to vestibular pain and, to a lesser extent, its anticipation, with fear and anxiety associated with responses to pain, supporting the introduction of anticipatory fear as a criterion of GPPPD in DSM-5., Highlights • Both subjective and brain responses during anticipation and induction of vestibular pain are increased in women with GPPPD. • Between-group differences were found in brain regions involved in cognitive and affective aspects of the pain experience. • These results support the addition of pain-related fear and anxiety in the diagnostic criteria of GPPPD in DSM-5.

Published
2017

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