Functional Magnetic Resonance Imaging of the Spinal Cord/Brainstem and Brain in Women With Provoked Vestibulodynia
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Authors
Yessick, Lindsey
Date
Type
thesis
Language
eng
Keyword
Provoked Vestibulodynia , Pelvic Pain , functional Magnetic Resonance Imaging , Spinal Cord/Brainstem Imaging
Alternative Title
Abstract
Vulvodynia (i.e., idiopathic chronic pain affecting the vulva) is a common but poorly understood pain condition, affecting 16% of women in the general population and leading to negative impacts in many life domains, including psychosocial function and reproductive potential (Pukall et al., 2016). An emerging body of research suggests that central factors (i.e., those involving the brain and spinal cord) may play a role in the etiology and/or maintenance of vulvodynia (Pukall et al., 2016).
Functional magnetic resonance imaging (fMRI) studies have indicated that women with provoked vestibulodynia (PVD)—a form of vulvodynia characterized by provoked pain in response to pressure applied to the vaginal entrance—exhibit increased neural activity in response to both genital and non-genital stimulation in cortical areas related to pain modulation (Hampson et al., 2013; Pukall et al., 2005; Sutton et al., 2015; Pazmany et al., 2017). However, despite the fundamental role of the brainstem and spinal cord in descending modulation of pain, no studies have attempted to examine activation patterns in the spinal cord of women with vulvodynia.
The aim of this study was to examine spinal cord and brain connectivity and activation in women with PVD during painful hand stimulation to evoke descending modulation, the process responsible for the descending control of pain involving brain, supraspinal, and spinal structures (Gebhart, 2004). We hypothesized that women with PVD would exhibit altered connectivity in regions of the brain and spinal cord, indicating diminished descending modulation, and would also have greater blood oxygen level dependent (BOLD) responses in regions previously associated with pain processing. The results of this study examining the spinal cord/brainstem revealed alterations in the connectivity and BOLD responses of regions related to pain modulation. Investigation of the brain revealed similar regions of connectivity in women with PVD and control women; however, this study adds to a growing body of research that have found alterations in the fMRI response of these brain regions in women with PVD. Through furthering our knowledge of spinally-mediated pain mechanisms in PVD, this study provides a more comprehensive understanding of the role of central processing in women with PVD.
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This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivs 3.0 United States
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivs 3.0 United States