Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, UCLA, Los Angeles, CA, United States.
Pediatric Pain and Palliative Care Program, Department of Pediatrics, UCLA, Los Angeles, CA, United States.
Pain. 2019 Jul;160(7):1529-1540. doi: 10.1097/j.pain.0000000000001532.
Multimodal neuroimaging studies provide support for a role of alterations in sensory processing circuits and endogenous pain modulatory systems in provoked vestibulodynia (PVD). In this study, we tested the hypotheses that PVD compared with healthy controls (HCs) would demonstrate gray matter volume (GMV) alterations in regions associated with sensorimotor, corticothalamic, and basal ganglia circuits. We also tested the replicability of previously reported gray matter increases in basal ganglia and hippocampal volumes in PVD vs HCs. In addition, disease specificity of GMV alterations were examined by comparing PVD with another chronic pain disorder. Finally, we examine whether GMV alterations are correlated with symptom measures. Structural magnetic resonance imaging was obtained in 119 premenopausal women (45 PVD, 45 HCs, and 29 irritable bowel syndrome [IBS]). A voxel-based morphometry analysis was applied to determine group differences in the hypothesized regions of interest. Compared with HCs, PVD women exhibited greater GMV in the basal ganglia, hippocampus, and sensorimotor cortices. Compared to patients with IBS, women with PVD had greater GMV in the hippocampus, and sensorimotor network, but lower GMV in the thalamus and precentral gyrus. Regional GMV alterations were associated with patient reports of pain during intercourse and muscle tenderness. The current findings provide further evidence that GMV is increased in PVD compared with HCs in several regions of the sensorimotor network and the hippocampus in patients with PVD. In addition, GMV distinct alterations in the sensorimotor network were identified between 2 pelvic pain disorders, PVD compared with IBS.
多模态神经影像学研究支持感觉处理回路和内源性疼痛调节系统改变在诱发性前庭性偏头痛（PVD）中的作用。在这项研究中，我们检验了以下假设：与健康对照组（HCs）相比，PVD 患者会表现出与感觉运动、皮质丘脑和基底神经节回路相关的区域的灰质体积（GMV）改变。我们还测试了先前报道的 PVD 与 HCs 相比基底神经节和海马体体积增加的 GMV 的可重复性。此外，通过将 PVD 与另一种慢性疼痛障碍进行比较，检查了 GMV 改变的疾病特异性。最后，我们检查 GMV 改变是否与症状测量相关。对 119 名绝经前妇女（45 名 PVD、45 名 HCs 和 29 名肠易激综合征 [IBS]）进行了结构磁共振成像。应用基于体素的形态测量分析来确定假设的感兴趣区域中的组间差异。与 HCs 相比，PVD 女性的基底神经节、海马体和感觉运动皮层的 GMV 更大。与 IBS 患者相比，PVD 女性的海马体和感觉运动网络的 GMV 更大，但丘脑和中央前回的 GMV 更小。区域 GMV 改变与患者报告的性交时疼痛和肌肉压痛有关。目前的研究结果进一步证明，与 HCs 相比，PVD 患者的感觉运动网络和海马体的几个区域的 GMV 增加。此外，在两种盆腔疼痛障碍之间，即 PVD 与 IBS 之间，确定了感觉运动网络中 GMV 的不同改变。
