Haugstad Gro Killi, Wojniusz Slawomir, Kirschner Rolf, Kirste Unni, Lilleheie Ingvild, Haugstad Tor S
Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
Cognitive Health in Trauma and Disease Research Group, Division of Clinical Neuroscience, Department of Neurology, Oslo University Hospital, Oslo, Norway.
Scand J Pain. 2019 Aug 14;19(4):725-732. doi: 10.1515/sjpain-2019-0011. Print 2019 Oct 25.
Provoked vestibulodynia (PVD) is a common persistent pain state among women in the Western world, causing dyspareunia, psychological distress and challenges against fertility. Therapies aimed at relieving pain (physiotherapy) and psychological distress (psychotherapy) are often recommended, sometimes in multimodal combinations. We have previously developed somatocognitive therapy (SCT) as a multimodal intervention, administered by a physiotherapist, to a different group of patients with gynecological pain, i.e. chronic (unprovoked) pelvic pain (CPP, also referred to as low abdominal pain). In a randomized, controlled study this intervention was shown to reduce pain experience and improve motor function or body awareness. Here we present the results of a clinical follow-up pilot study with 30 women with PVD, applying SCT administered by third year bachelor students in physiotherapy. Main outcome was pain experience, secondary outcomes were psychological distress and motor functions of the patients.
Thirty women diagnosed with PVD were recruited from a tertiary university hospital clinic of gynecology, and included in the follow-up pilot study at an out-patient physiotherapy clinic. Each patient participated in 10-14 therapy sessions over 6 weeks. The students were supervised by an experienced physiotherapist with extensive background in this clinical area, who also performed two clinical sessions with each of the patients at the end of the treatment period. Before therapy, the patients were evaluated for pain experience (visual analogue scale of pain, VAS), psychological distress (Tampa scale of kinesiophobia, TSK) and General Health Questionnaire (GHQ-30) as well as body function (standardized Mensendieck test, SMT). Statistical analyzes were performed by using the average ± standard deviation, statistical significance of changes calculated by means of the -test.
Average pain score before therapy were 7.77 ± 1.98, after 6 weeks of intervention 4.17 ± 2.07 and at 6 months' follow-up 1.66 ± 1.08 (average ± standard deviation), changes being significant below < 0.01 level. Secondary outcome variables assessing psychological distress and sub optimal motor patterns were also significantly improved. For example, anxiety and depression scores were reduced by approximately 40%, and respiration pattern score improved by almost 80%.
Multimodal somatocognitive therapy reduced levels of pain and psychological distress, and improved motor functions in women with PVD after 6 weeks of interventions. All variables were further improved at 6 months' follow-up. Thus, somatocognitive therapy may be a useful treatment option for patients with PVD. However, there are limitations to this study, since there was no control group, and suboptimal blinding during assessment of the data.
Somatocognitive therapy may be a useful tool when treating PVD patients. More studies, in particular RCTs, should be performed to further evaluate this intervention and corroborate the results from this pilot study.
激发性前庭痛（PVD）是西方世界女性中常见的持续性疼痛状态，会导致性交困难、心理困扰以及生育问题。通常推荐采用旨在缓解疼痛（物理治疗）和心理困扰（心理治疗）的疗法，有时采用多模式联合治疗。我们之前已开发出体认知疗法（SCT），作为一种由物理治疗师实施的多模式干预方法，用于另一组患有妇科疼痛的患者，即慢性（非激发性）盆腔疼痛（CPP，也称为下腹部疼痛）。在一项随机对照研究中，该干预措施被证明可减轻疼痛体验并改善运动功能或身体感知。在此，我们展示了一项针对30名患有PVD的女性的临床随访试点研究结果，采用由物理治疗专业三年级本科生实施的SCT。主要结局是疼痛体验，次要结局是患者的心理困扰和运动功能。
从一家三级大学医院的妇科诊所招募了30名被诊断为PVD的女性，并纳入门诊物理治疗诊所的随访试点研究。每位患者在6周内参加10 - 14次治疗课程。学生们由一位在该临床领域有丰富背景的经验丰富的物理治疗师监督，该治疗师在治疗期结束时也与每位患者进行了两次临床治疗。治疗前，对患者进行疼痛体验（视觉模拟疼痛量表，VAS）、心理困扰（坦帕运动恐惧量表，TSK）和一般健康问卷（GHQ - 30）以及身体功能（标准化门森迪克测试，SMT）评估。采用平均值±标准差进行统计分析，通过t检验计算变化的统计学显著性。
治疗前平均疼痛评分为7.77±1.98，干预6周后为4.17±2.07，6个月随访时为1.66±1.08（平均值±标准差），变化在<0.01水平具有显著性。评估心理困扰和次优运动模式的次要结局变量也有显著改善。例如，焦虑和抑郁评分降低了约40%，呼吸模式评分提高了近80%。
多模式体认知疗法在干预6周后降低了PVD女性的疼痛水平和心理困扰，并改善了运动功能。所有变量在6个月随访时进一步改善。因此，体认知疗法可能是PVD患者的一种有效治疗选择。然而，本研究存在局限性，因为没有对照组，且数据评估过程中存在次优的盲法。
体认知疗法在治疗PVD患者时可能是一种有用的工具。应开展更多研究，尤其是随机对照试验，以进一步评估该干预措施并证实本试点研究的结果。
