Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium.
Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
Neuroimage Clin. 2017 Jul 25;16:477-490. doi: 10.1016/j.nicl.2017.07.017. eCollection 2017.
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.
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.
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.
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.
在 DSM-5 中，对阴道插入的预期过程中与疼痛相关的恐惧是生殖器疼痛/插入障碍（GPPPD）的诊断标准。我们旨在研究 GPPPD 女性在预期性恐惧期间以及随后前庭疼痛诱发时的主观和大脑反应。
GPPPD 女性（n=18）和年龄匹配的健康对照组（HC）（n=15）在经过提示的预期期后，在个体滴定的疼痛阈值下进行前庭疼痛诱发时接受 fMRI 扫描。在扫描前用问卷测量（与疼痛相关的）恐惧和焦虑特质，在扫描期间使用视觉模拟量表评估预期恐惧和疼痛强度。
GPPPD 女性报告的预期恐惧和疼痛强度明显更高。在预期和疼痛诱发期间，她们在涉及疼痛感知认知和情感方面的区域中具有更强和更广泛的大脑反应，但在预期条件下，组间差异没有达到显著性。GPPPD 中的疼痛相关恐惧和焦虑特质以及预期恐惧评分与疼痛评分呈正相关，但在 HC 中则没有。此外，在 HC 中，与认知和情感方面的疼痛感知区域相关的预期恐惧评分与大脑反应之间存在负相关，但在 GPPPD 女性中则没有。
GPPPD 女性的特征是对前庭疼痛及其预期的主观和大脑反应增加，而对疼痛的恐惧和焦虑则与反应相关，支持在 DSM-5 中将预期恐惧作为 GPPPD 的标准。
