The Role of Attention, Catastrophizing, and Anxiety in the Experience of Chronic Pain: Imaging Pain in Women With and Without Vestibulodynia

Abstract

Provoked Vestibulodynia (PVD) is the most common form of chronic vulvar pain, affecting 12% of women in the general population. Research has demonstrated that women with PVD display both allodynia and hyperalgesia to pain at vulvar and non-vulvar sites, as well as reduced psychosocial functioning. The goal of this study was to use a multi-method approach (interview, questionnaires, sensory testing, and fMRI) to examine group differences between women with PVD (N=15) and healthy control women (N=15). Results will allow for improved understanding of the interaction between psychosocial and neurobiological underpinnings of this disorder, which can contribute to the creation of better treatment strategies. Variables included psychophysical and psychosocial measures, as well as neural activations associated with painful pressure, painful words, and psychosocial functioning. Differences between subgroups of PVD, based on temporal onset, were also examined. There were no robust group differences in neural activation during the application of pain or pain words. This finding is consistent with many studies that match groups on pain intensity ratings, as opposed to amount of pressure applied. Painful pressures and painful words resulted in greater neural activation than neutral words or touch; however, there were no group differences for the word conditions. Women with PVD reported increased psychosocial dysfunction, including higher levels of anxiety and catastrophizing. Significant correlations were found between these psychosocial variables and areas of the brain associated with pain modulation and attention (e.g., PFC). Examination of PVD subgroups revealed differences in neural correlates of anxiety and catastrophizing during painful stimulation. This finding adds to the literature suggesting that women with primary PVD experience greater dysfunction than women with secondary PVD. Overall, these studies support findings of pain processing in the general pain literature, as well as supporting PVD as a chronic pain condition. They also add to the development of a greater understanding of the interaction between psychophysical and psychosocial components of chronic pain by examining their relationship with neural activations. Future research should examine brain functioning in PVD women pre- and post-treatment as well as examining neural correlates of other psychosocial variables that contribute to the pain experience (e.g., somatization).