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      Vulvodynia is not created equally: empirical classification of women with vulvodynia

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          Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity.


          The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry. We hypothesized that women with vulvodynia can be clustered into subgroups based on distress and pain sensitivity.


          A cross-sectional study.


          We conducted an exploratory hierarchical agglomerative cluster analysis using Ward’s cluster method and squared Euclidean distances to identify unique subgroups based on baseline psychological distress and pain sensitivity. The variables included the catastrophizing subscale of the Coping Strategies Questionnaire, the Beck Depression Inventory, the State Trait Anxiety Index-Trait scale, McGill Pain Questionnaire-Affective subscale, and vulvar and pelvic muscle pressure pain sensitivity.


          Eight sites enrolled women who presented with vaginal or vulval pain of at least 3-month duration.


          Two distinct subgroups, high pain sensitivity with high distress (n=27) and low pain sensitivity with low distress (n=100), emerged from the cluster analysis. Validation indicated that subgroups differed in terms of clinical pain intensity, sensory aspects of pain, and intercourse pain.


          Empirical classification indicates that unique subgroups exist in women with vulvodynia. Providers should be aware of the heterogeneity of this condition with respect to pain-related distress and pain sensitivity.

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          Most cited references 47

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          Pain catastrophizing: a critical review.

          Pain catastrophizing is conceptualized as a negative cognitive-affective response to anticipated or actual pain and has been associated with a number of important pain-related outcomes. In the present review, we first focus our efforts on the conceptualization of pain catastrophizing, highlighting its conceptual history and potential problem areas. We then focus our discussion on a number of theoretical mechanisms of action: appraisal theory, attention bias/information processing, communal coping, CNS pain processing mechanisms, psychophysiological pathways and neural pathways. We then offer evidence to suggest that pain catastrophizing represents an important process factor in pain treatment. We conclude by offering what we believe represents an integrated heuristic model for use by researchers over the next 5 years; a model we believe will advance the field most expediently.
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            The cognitive activation theory of stress.

            This paper presents a cognitive activation theory of stress (CATS), with a formal system of systematic definitions. The term "stress" is used for four aspects of "stress", stress stimuli, stress experience, the non-specific, general stress response, and experience of the stress response. These four meanings may be measured separately. The stress response is a general alarm in a homeostatic system, producing general and unspecific neurophysiological activation from one level of arousal to more arousal. The stress response occurs whenever there is something missing, for instance a homeostatic imbalance, or a threat to homeostasis and life of the organism. Formally, the alarm occurs when there is a discrepancy between what should be and what is-between the value a variable should have (set value (SV)), and the real value (actual value (AV)) of the same variable. The stress response, therefore, is an essential and necessary physiological response. The unpleasantness of the alarm is no health threat. However, if sustained, the response may lead to illness and disease through established pathophysiological processes ("allostatic load"). The alarm elicits specific behaviors to cope with the situation. The level of alarm depends on expectancy of the outcome of stimuli and the specific responses available for coping. Psychological defense is defined as a distortion of stimulus expectancies. Response outcome expectancies are defined as positive, negative, or none, to the available responses. This offers formal definitions of coping, hopelessness, and helplessness that are easy to operationalize in man and in animals. It is an essential element of CATS that only when coping is defined as positive outcome expectancy does the concept predict relations to health and disease.
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              What is the maximum number of levels needed in pain intensity measurement?

              An important issue that has yet to be resolved in pain measurement literature concerns the number of levels needed to assess self-reported pain intensity. An examination of treatment outcome literature shows a large variation in the number of levels used, from as few as 4 (e.g., 4-point Verbal Rating scales (VRS)) to as many as 101 (e.g., 101-point Numerical Rating scales (NRS)). The purpose of this study was to provide an empirically derived guideline for determining the number of levels needed. Chronic pain patients (n = 124) provided pre- and post-treatment measures of pain intensity using 101-point NRS for least, most, current, and average pain. The patients' responses to the measures were examined closely to determine the actual number of levels used. In addition, their responses to the 101-point scales were recorded to form 7 scales of varying levels (2- to 101-point scales). The sensitivity of the 7 recorded scales was examined. The results indicated that little information is lost if 101-point scales are coded as 11- or 21-point scales. Moreover, examination of the actual responses to the 101-point measure showed that almost all patients treated it as a 21-point scale by providing responses in multiples of 5 or 10, while a substantial number of patients treated it as an 11-point scale, providing responses in multiples of 10 only. The results suggest that 10- and 21-point scales provide sufficient levels of discrimination, in general, for chronic pain patients to describe pain intensity.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                06 July 2017
                : 10
                : 1601-1609
                [1 ]Department of Physical Therapy
                [2 ]Center for Pain Research and Behavioral Health, University of Florida, Gainesville
                [3 ]Division of Surgery, Gynecology Section, Veteran Affairs Medical Center
                [4 ]University of Central Florida, Orlando, FL
                [5 ]Women’s Integrated Health Program, Department of OBGYN, Denver Health Medical Center, Denver, CO
                [6 ]Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
                [7 ]Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
                Author notes
                Correspondence: Meryl Alappattu, Department of Physical Therapy, University of Florida, P.O. Box 100154, Gainesville, FL 32610 0154, USA, Tel +1 352 273 9661, Fax +1 352 273 6109, Email meryl@ 123456ufl.edu
                © 2017 Alappattu et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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