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Pain. 2019 Feb 25. doi: 10.1097/j.pain.0000000000001532. [Epub ahead of print]

Altered Gray Matter Volume in Sensorimotor and Thalamic Regions associated with Pain in Localized Provoked Vulvodynia: A Voxel-based Morphometry Study.

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Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, UCLA.
Pediatric Pain and Palliative Care Program, UCLA.
David Geffen School of Medicine, UCLA.
UCLA Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA.
Department of Obstetrics and Gynecology, UCLA.
Institute for Family and Sexuality Studies, KU Leuven.
Translational Research Center for Gastrointestinal Disorders, University of Leuven.
Geneva University Hospitals.
Brain Research Institute, UCLA.


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 to 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 versus HCs. Additionally, disease-specificity of GMV alterations were examined by comparing PVD to 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, 29 irritable bowel syndrome (IBS)). A voxel-based morphometry analysis was applied to determine group differences in the hypothesized regions of interest. Compared to HCs, PVD women exhibited greater GMV in the basal ganglia, hippocampus, and sensorimotor cortices. Compared to IBS patients, women with PVD had greater GMV in the hippocampus, and sensorimotor network, but lower GMV in the thalamus and precentral gyrus. Regional gray matter volume alterations were associated with patient reports of pain during intercourse and muscles tenderness. The current findings provide further evidence that GMV is increased in PVD compared to HCs in several regions of the sensorimotor network and the hippocampus in PVD patients. In addition, GMV distinct alterations in the sensorimotor network were identified between two pelvic pain disorders, PVD compared to irritable bowel syndrome.

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