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Medical Professionals
Research Priorities
Recommendations and Research Priorities from the Vulvodynia Workshop
(from Workshop Proceedings, published by the ORWH)
April 2-3, 1997
Lister Hill Auditorium, NIH
Bethesda, Maryland
Role of the ISSVD
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Refine the definition of vulvodynia
- time point for chronicity
- inclusion/exclusion criteria
- include a physical finding in definition
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Dissemination of definition
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Coordination of clinical trials
Multicenter Therapeutic Trials – I
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START!
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Need for coordinating center for access to patients
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Clinical trials group should:
- develop diagnostic criteria
- define subsets (e.g., psychological impairment)
- develop tools for measuring endpoints – pain, function,
psychological measures, quality of life measures
Multicenter Therapeutic Trials – II
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Intralesional IFN-a, capsaicin, topical anesthetics, low-oxalate diet
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Undertake trials using multi-disciplinary approach with three elements:
- low-dose tricyclics vs Flexoril
- aerobic exercise
- cognitive behavioral therapy
Pelvic Floor
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Develop, validate, standardize methods for evaluation of pelvic floor
functions – establish normals
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Characterize abnormal pelvic floor activity in patients with vulvar pain
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Evaluate the effect of treatment on vulvar pain and pelvic floor functions
Epidemiology
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Conduct case-controlled or population studies
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Use existing data collection instruments and develop new vulvodynia-
specific questions as needed
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Identify group at high risk – will allow prospective studies
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Seek influence of psychosocial correlates (depression, anxiety, trauma,
child abuse)
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Look into current models used by other pain groups
Surgical Therapy
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Conduct a retrospective, multicenter analysis of pooled surgical cases
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Set up a prospective, randomized multicenter study
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Define population – stratify pain/functional levels
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Define surgical procedure(s)
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Define endpoints
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Develop audiovisual teaching aids – set up a working group
Clinical Studies
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Well-defined population – set up rigorous inclusion/exclusion criteria
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Well-controlled – (placebo, randomized, double-blind, cross-over, case-
controlled)
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Standardized clinical rating scales – "measure development" for use
across multiple treatment studies
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Define endpoints
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Integrate psycho-sexual history
Infections
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Examine role of HSV and HPV with modern methods
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Evaluate role or past-present YEAST infection
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Define vaginal microflora – correlate with cytokines
*Women to be enrolled in vulvodynia studies should:
- be free from other infections
(BV, GC, chlamydia, trichomonas, HSV, candida)
- not have had any antibiotics in previous two weeks
Pain Research
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Develop animal model for neuropathic conditions of the pelvic floor
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Using animal models, evaluate the sensory and motor pathways and
central neural control of pelvic floor
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Look for evidence of sympathetic involvement
- afferent nerve sensitivity involvement
- tilt tables
- use agonists/antagonists
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Look for evidence of central sensitization – exquisite sensory testing in the
vulva
The National Vulvodynia Association is a nonprofit organization that strives to improve women's lives through education, support, advocacy and research
funding. The NVA is not a medical authority and strongly recommends that you consult your own health care provider regarding any course of treatment or medication.
Last Updated on February 2, 2012
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