Functional Magnetic Resonance Imaging of the Spinal Cord/Brainstem and Brain in Women With Provoked Vestibulodynia
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.
URI for this recordhttp://hdl.handle.net/1974/24898
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