Efficacy of transcranial direct-current stimulation (tDCS) in women with provoked vestibulodynia: study protocol for a randomized controlled trial

Annie Morin, Guillaume Léonard, Véronique Gougeon, Guy Waddell, Yves-André Bureau, Isabelle Girard, Mélanie Morin, Annie Morin, Guillaume Léonard, Véronique Gougeon, Guy Waddell, Yves-André Bureau, Isabelle Girard, Mélanie Morin

Abstract

Background: Provoked vestibulodynia is the most common form of vulvodynia. Despite its high prevalence and deleterious sexual, conjugal, and psychological repercussions, effective evidence-based interventions for provoked vestibulodynia remain limited. For a high proportion of women, significant pain persists despite the currently available treatments. Growing evidence suggests that the central nervous system (CNS) could play a key role in provoked vestibulodynia; thus, treatment targeting the CNS, rather than localized dysfunctions, may be beneficial for women suffering from provoked vestibulodynia. In this study, we aim to build on the promising results of a previous case report and evaluate whether transcranial direct-current stimulation, a non-invasive brain stimulation technique targeting the CNS, could be an effective treatment option for women with provoked vestibulodynia.

Methods/design: This single-center, triple-blind, parallel group, randomized, controlled trial aims to compare the efficacy of transcranial direct-current stimulation with sham transcranial direct-current stimulation in women with provoked vestibulodynia. Forty women diagnosed with provoked vestibulodynia by a gynecologist, following a standardized treatment protocol, are randomized to either active transcranial direct-current stimulation treatment for ten sessions of 20 minutes at an intensity of 2 mA or sham transcranial direct-current stimulation over a 2-week period. Outcome measures are collected at baseline, 2 weeks after treatment and at 3-month follow-up. The primary outcome is pain during intercourse, assessed with a numerical rating scale. Secondary measurements focus on the sexual function, vestibular pain sensitivity, psychological distress, treatment satisfaction, and the patient's global impression of change.

Discussion: To our knowledge, this study is the first randomized controlled trial to examine the efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia. Findings from this trial are expected to provide significant information about a promising intervention targeting the centralization of pain in women with provoked vestibulodynia.

Trial registration: Clinicaltrials.gov, NCT02543593 . Registered on September 4, 2015.

Keywords: Chronic pain; Dyspareunia; Psychological distress; Randomized clinical trial; Sexual dysfunction; Transcranial direct-current stimulation; Treatment outcome; Vestibulodynia.

Figures

Fig. 1
Fig. 1
Study flow diagram

References

    1. Harlow BL, Kunitz CG, Nguyen RHN, Rydell SA, Turner RM, Maclehose RF. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am J Obstet Gynecol. 2014;210(1):40.e1-.e8. doi: 10.1016/j.ajog.2013.09.033.
    1. Friedrich EG., Jr Vulvar vestibulitis syndrome. J Reprod Med. 1987;32(2):110–4.
    1. Payne KA, Binik YM, Amsel R, Khalife S. When sex hurts, anxiety and fear orient attention towards pain. Eur J Pain (London, England) 2005;9(4):427–36. doi: 10.1016/j.ejpain.2004.10.003.
    1. Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol. 2006;107(3):617–24. doi: 10.1097/01.AOG.0000199951.26822.27.
    1. Desrochers G, Bergeron S, Landry T, Jodoin M. Do psychosexual factors play a role in the etiology of provoked vestibulodynia? a critical review. J Sex Marital Ther. 2008;34(3):198–226. doi: 10.1080/00926230701866083.
    1. Gordon AS, Panahian-Jand M, McComb F, Melegari C, Sharp S. Characteristics of women with vulvar pain disorders: responses to a web-based survey. J Sex Marital Ther. 2003;29(Suppl 1):45–58. doi: 10.1080/713847126.
    1. Haefner HK, Collins ME, Davis GD, Edwards L, Foster DC, Hartmann ED, et al. The vulvodynia guideline. J Low Genit Tract Dis. 2005;9(1):40–51. doi: 10.1097/00128360-200501000-00009.
    1. Goldfinger C, Pukall CF, Gentilcore-Saulnier E, McLean L, Chamberlain S. A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med. 2009;6(7):1955–68. doi: 10.1111/j.1743-6109.2009.01304.x.
    1. Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol Scand. 2006;85(11):1360–7. doi: 10.1080/00016340600883401.
    1. Dykstra DD, Presthus J. Botulinum toxin type A for the treatment of provoked vestibulodynia: an open-label, pilot study. J Reprod Med. 2006;51(6):467–70.
    1. Goldstein A, Burrows L, Goldstein I. Can oral contraceptives cause vestibulodynia? J Sex Med. 2010;7(4 Pt 1):1585–7. doi: 10.1111/j.1743-6109.2009.01685.x.
    1. Landry T, Bergeron S, Dupuis MJ, Desrochers G. The treatment of provoked vestibulodynia: a critical review. Clin J Pain. 2008;24(2):155–71. doi: 10.1097/AJP.0b013e31815aac4d.
    1. Bergeron S, Binik YM, Khalife S, Pagidas K, Glazer HI, Meana M, et al. A randomized comparison of group cognitive--behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91(3):297–306. doi: 10.1016/S0304-3959(00)00449-8.
    1. Pukall C, Kandyba K, Amsel R, Khalife S, Binik Y. Effectiveness of hypnosis for the treatment of vulvar vestibulitis syndrome: a preliminary investigation. J Sex Med. 2007;4(2):417–25. doi: 10.1111/j.1743-6109.2006.00425.x.
    1. Powell J, Wojnarowska F. Acupuncture for vulvodynia. J R Soc Med. 1999;92(11):579–81.
    1. Reed BD, Caron AM, Gorenflo DW, Haefner HK. Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. J Low Genit Tract Dis. 2006;10(4):245–51. doi: 10.1097/01.lgt.0000225899.75207.0a.
    1. Pukall CF, Smith KB, Chamberlain SM. Provoked vestibulodynia. Womens Health (Lond Engl) 2007;3(5):583–92. doi: 10.2217/17455057.3.5.583.
    1. Stockdale CK, Lawson HW. 2013 Vulvodynia guideline update. J Low Genit Tract Dis. 2014;18(2):93–100. doi: 10.1097/LGT.0000000000000021.
    1. Woolf CJ. Central sensitization: uncovering the relation between pain and plasticity. Anesthesiology. 2007;106(4):864–7. doi: 10.1097/01.anes.0000264769.87038.55.
    1. Simis M, Reidler JS, Duarte Macea D, Moreno Duarte I, Wang X, Lenkinski R, et al. Investigation of central nervous system dysfunction in chronic pelvic pain using magnetic resonance spectroscopy and noninvasive brain stimulation. Pain Pract. 2015;15(5):423–32. doi: 10.1111/papr.12202.
    1. Giesecke J, Reed BD, Haefner HK, Giesecke T, Clauw DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104(1):126–33. doi: 10.1097/01.AOG.0000129238.49397.4e.
    1. Granot M, Friedman M, Yarnitsky D, Zimmer EZ. Enhancement of the perception of systemic pain in women with vulvar vestibulitis. BJOG. 2002;109(8):863–6. doi: 10.1111/j.1471-0528.2002.01416.x.
    1. Pukall CF, Binik YM, Khalife S, Amsel R, Abbott FV. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain. 2002;96(1-2):163–75. doi: 10.1016/S0304-3959(01)00442-0.
    1. Pukall CF, Strigo IA, Binik YM, Amsel R, Khalife S, Bushnell MC. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005;115(1-2):118–27. doi: 10.1016/j.pain.2005.02.020.
    1. Cook DB, Lange G, Ciccone DS, Liu WC, Steffener J, Natelson BH. Functional imaging of pain in patients with primary fibromyalgia. J Rheumatol. 2004;31(2):364–78.
    1. Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. 2002;46(5):1333–43. doi: 10.1002/art.10225.
    1. Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004;127(Pt 4):835–43. doi: 10.1093/brain/awh098.
    1. Bernstein CN, Frankenstein UN, Rawsthorne P, Pitz M, Summers R, McIntyre MC. Cortical mapping of visceral pain in patients with GI disorders using functional magnetic resonance imaging. Am J Gastroenterol. 2002;97(2):319–27. doi: 10.1111/j.1572-0241.2002.05464.x.
    1. Chang L, Berman S, Mayer EA, Suyenobu B, Derbyshire S, Naliboff B, et al. Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia. Am J Gastroenterol. 2003;98(6):1354–61. doi: 10.1111/j.1572-0241.2003.07478.x.
    1. Mertz H, Morgan V, Tanner G, Pickens D, Price R, Shyr Y, et al. Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. Gastroenterology. 2000;118(5):842–8. doi: 10.1016/S0016-5085(00)70170-3.
    1. Naliboff BD, Derbyshire SW, Munakata J, Berman S, Mandelkern M, Chang L, et al. Cerebral activation in patients with irritable bowel syndrome and control subjects during rectosigmoid stimulation. Psychosom Med. 2001;63(3):365–75. doi: 10.1097/00006842-200105000-00006.
    1. Ringel Y, Drossman DA, Turkington TG, Bradshaw B, Hawk TC, Bangdiwala S, et al. Regional brain activation in response to rectal distension in patients with irritable bowel syndrome and the effect of a history of abuse. Dig Dis Sci. 2003;48(9):1774–81. doi: 10.1023/A:1025455330704.
    1. Verne GN, Himes NC, Robinson ME, Gopinath KS, Briggs RW, Crosson B, et al. Central representation of visceral and cutaneous hypersensitivity in the irritable bowel syndrome. Pain. 2003;103(1-2):99–110. doi: 10.1016/S0304-3959(02)00416-5.
    1. Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum. 2004;50(2):613–23. doi: 10.1002/art.20063.
    1. Schweinhardt P, Kuchinad A, Pukall CF, Bushnell MC. Increased gray matter density in young women with chronic vulvar pain. Pain. 2008;140(3):411–9. doi: 10.1016/j.pain.2008.09.014.
    1. Zolnoun DA, Rohl J, Moore CG, Perinetti-Liebert C, Lamvu GM, Maixner W. Overlap between orofacial pain and vulvar vestibulitis syndrome. Clin J Pain. 2008;24(3):187–91. doi: 10.1097/AJP.0b013e318159f976.
    1. Hauser W, Petzke F, Uceyler N, Sommer C. Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran in fibromyalgia syndrome: a systematic review with meta-analysis. Rheumatology (Oxford) 2011;50(3):532–43. doi: 10.1093/rheumatology/keq354.
    1. Chao GQ, Zhang S. A meta-analysis of the therapeutic effects of amitriptyline for treating irritable bowel syndrome. Intern Med (Tokyo, Japan) 2013;52(4):419–24. doi: 10.2169/internalmedicine.52.9147.
    1. Brown CS, Wan J, Bachmann G, Rosen R. Self-management, amitriptyline, and amitripyline plus triamcinolone in the management of vulvodynia. J Womens Health (Larchmt) 2009;18(2):163–9. doi: 10.1089/jwh.2007.0676.
    1. Vaseghi B, Zoghi M, Jaberzadeh S. Does anodal transcranial direct current stimulation modulate sensory perception and pain? a meta-analysis study. Clin Neurophysiol. 2014;125(9):1847–58. doi: 10.1016/j.clinph.2014.01.020.
    1. Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, et al. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain. 2006;122(1-2):197–209. doi: 10.1016/j.pain.2006.02.023.
    1. Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L, et al. A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis Rheum. 2006;54(12):3988–98. doi: 10.1002/art.22195.
    1. Mori F, Codeca C, Kusayanagi H, Monteleone F, Buttari F, Fiore S, et al. Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis. J Pain. 2010;11(5):436–42. doi: 10.1016/j.jpain.2009.08.011.
    1. Kim YJ, Ku J, Kim HJ, Im DJ, Lee HS, Han KA, et al. Randomized, sham controlled trial of transcranial direct current stimulation for painful diabetic polyneuropathy. Ann Rehabil Med. 2013;37(6):766–76. doi: 10.5535/arm.2013.37.6.766.
    1. Fenton BW, Palmieri PA, Boggio P, Fanning J, Fregni F. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimul. 2009;2(2):103–7. doi: 10.1016/j.brs.2008.09.009.
    1. Antal A, Terney D, Kuhnl S, Paulus W. Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition. J Pain Symptom Manage. 2010;39(5):890–903. doi: 10.1016/j.jpainsymman.2009.09.023.
    1. Thibaut A, Chatelle C, Gosseries O, Laureys S, Bruno MA. Transcranial direct current stimulation: a new tool for neurostimulation. Rev Neurol. 2013;169(2):108–20. doi: 10.1016/j.neurol.2012.05.008.
    1. O’Connell NE, Wand BM, Marston L, Spencer S, Desouza LH. Non-invasive brain stimulation techniques for chronic pain: a report of a Cochrane systematic review and meta-analysis. Eur J Phys Rehabil Med. 2011;47(2):309–26.
    1. Cecilio SB, Zaghi S, Cecilio LB, Correa CF, Fregni F. Exploring a novel therapeutic approach with noninvasive cortical stimulation for vulvodynia. Am J Obstet Gynecol. 2008;199(6):e6–7. doi: 10.1016/j.ajog.2008.08.034.
    1. Morin M, Bergeron S, Khalife S, Mayrand MH, Binik YM. Morphometry of the pelvic floor muscles in women with and without provoked vestibulodynia using 4D ultrasound. J Sex Med. 2014;11(3):776–85. doi: 10.1111/jsm.12367.
    1. Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalife S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther. 2002;28(3):183–92. doi: 10.1080/009262302760328226.
    1. Bergeron S, Binik YM, Khalife S, Pagidas K, Glazer HI. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol. 2001;98(1):45–51.
    1. Corsini-Munt S, Bergeron S, Rosen NO, Steben M, Mayrand MH, Delisle I, et al. A comparison of cognitive-behavioral couple therapy and lidocaine in the treatment of provoked vestibulodynia: study protocol for a randomized clinical trial. Trials. 2014;15:506. doi: 10.1186/1745-6215-15-506.
    1. Morin M, Dumoulin C, Bergeron S, Mayrand MH, Khalife S, Waddell G, et al. Randomized clinical trial of physiotherapy treatment compared to overnight lidocaine ointment in women suffering from provoked vestibulodynia: design and methods. Contemp Clinic Trials. 2016;46:52–9. doi: 10.1016/j.cct.2015.11.013.
    1. Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med. 2004;49(10):772–7.
    1. Reidler JS, Mendonca ME, Santana MB, Wang X, Lenkinski R, Motta AF, et al. Effects of motor cortex modulation and descending inhibitory systems on pain thresholds in healthy subjects. J Pain. 2012;13(5):450–8. doi: 10.1016/j.jpain.2012.01.005.
    1. Soler MD, Kumru H, Pelayo R, Vidal J, Tormos JM, Fregni F, et al. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain. 2010;133(9):2565–77. doi: 10.1093/brain/awq184.
    1. Nitsche MA, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001;57(10):1899–901. doi: 10.1212/WNL.57.10.1899.
    1. Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J, et al. Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): review and recommendations from an expert panel. Clin Res Regul Aff. 2014;32(1):22–35. doi: 10.3109/10601333.2015.980944.
    1. Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Clin Neurophysiol. 2003;114(11):2220–2. doi: 10.1016/S1388-2457(03)00235-9.
    1. Gandiga PC, Hummel FC, Cohen LG. Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation. Clin Neurophysiol. 2006;117(4):845–50. doi: 10.1016/j.clinph.2005.12.003.
    1. Marchand S, Li J, Charest J. Effects of caffeine on analgesia from transcutaneous electrical nerve stimulation. N Engl J Med. 1995;333(5):325–6. doi: 10.1056/NEJM199508033330521.
    1. Leonard G, Goffaux P, Mathieu D, Blanchard J, Kenny B, Marchand S. Evidence of descending inhibition deficits in atypical but not classical trigeminal neuralgia. Pain. 2009;147(1-3):217–23. doi: 10.1016/j.pain.2009.09.009.
    1. Bohm-Starke N, Hilliges M, Blomgren B, Falconer C, Rylander E. Increased blood flow and erythema in the posterior vestibular mucosa in vulvar vestibulitis(1) Obstet Gynecol. 2001;98(6):1067–74.
    1. Morin M, Dumoulin C, Bergeron S, Mayrand MH, Khalife S, Waddell G et al., editors. PVD Study Group. Randomized controlled trial of multimodal physiotherapy treatment compared to overnight topical lidocaine in women suffering from provoked vestibulodynia. 40th Annual Meeting of the International Urogynecological Association; 2015; Nice, France, Int Urogynecol J, 1(Supp – June 2015), PP22.
    1. Cyr M-P, Bourbonnais D, Pinard A, Dubois O, Morin M. Reliability and convergent validity of the algometer for vestibular pain assessment in women with provoked vestibulodynia. Pain Med. 2015. doi:10.1093/pm/pnv069.
    1. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1-2):9–19. doi: 10.1016/j.pain.2004.09.012.
    1. Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999;79(2):231–52. doi: 10.1016/S0039-6109(05)70381-9.
    1. Morin M, Bergeron S, Khalife S, Binik I, Ouellet S. Dynamometric assessment of the pelvic floor muscle function in women with and without provoked vestibulodynia. NeurourolUrodyn. 2010;29:1140–1.
    1. Morin M, Bergeron S, Khalife S, Binik I, Mayrand MH. Morphometry of the pelvic floor muscles in women with and without provoked vestibuylodynia using 3D/4D ultrasonography. J Sex Med. 2011;8 suppl 2:56.
    1. Bergeron S, Khalife S, Dupuis MJ, editors. Provoked vestibulodynia: a randomized comparison of cognitive-behavioral therapy and medical management. Communicatoin presentée dans le cadre d’un symposium au congrès annuel de l’International Society for the Study of Women and Sexual Health; 2008.
    1. Turk DC, Dworkin RH, Burke LB, Gershon R, Rothman M, Scott J, et al. Developing patient-reported outcome measures for pain clinical trials: IMMPACT recommendations. Pain. 2006;125(3):208–15. doi: 10.1016/j.pain.2006.09.028.
    1. Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1(3):277–99. doi: 10.1016/0304-3959(75)90044-5.
    1. Davidoff G, Guarracini M, Roth E, Sliwa J, Yarkony G. Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study. Pain. 1987;29(2):151–61. doi: 10.1016/0304-3959(87)91032-3.
    1. Hays H, Hagen N, Thirlwell M, Dhaliwal H, Babul N, Harsanyi Z, et al. Comparative clinical efficacy and safety of immediate release and controlled release hydromorphone for chronic severe cancer pain. Cancer. 1994;74(6):1808–16. doi: 10.1002/1097-0142(19940915)74:6<1808::AID-CNCR2820740625>;2-Y.
    1. Bansal D, Bhansali A, Hota D, Chakrabarti A, Dutta P. Amitriptyline vs. pregabalin in painful diabetic neuropathy: a randomized double blind clinical trial. Diabet Med. 2009;26(10):1019–26. doi: 10.1111/j.1464-5491.2009.02806.x.
    1. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X. Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril. 2011;95(2):583–7. doi: 10.1016/j.fertnstert.2010.05.024.
    1. Foster DC, Kotok MB, Huang LS, Watts A, Oakes D, Howard FM, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116(3):583–93. doi: 10.1097/AOG.0b013e3181e9e0ab.
    1. van Lankveld JJ, Granot M, Weijmar Schultz WC, Binik YM, Wesselmann U, Pukall CF, et al. Women’s sexual pain disorders. J Sex Med. 2010;7(1 Pt 2):615–31. doi: 10.1111/j.1743-6109.2009.01631.x.
    1. Cyr MP, Morin M, Pinard A, Dubois O, Bourbonnais D. Reliability and validity of a new instrument for vestibular pain assessment in women with provoked vestibulodynia. J Sex Med. 2014;11(suppl 4):213–37.
    1. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208. doi: 10.1080/009262300278597.
    1. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20. doi: 10.1080/00926230590475206.
    1. Lawrance K, Byers ES. Sexual satisfaction in long-term heterosexual relationship: The Interpersonal exchange model of sexual satisfaction. Pers Relat. 1995;2:267–85. doi: 10.1111/j.1475-6811.1995.tb00092.x.
    1. Meana M, Binik YM, Khalife S, Cohen DR. Biopsychosocial profile of women with dyspareunia. Obstet Gynecol. 1997;90(4 Pt 1):583–9. doi: 10.1016/S0029-7844(98)80136-1.
    1. French D, Noel M, Vigneau F, French J, Cyr C, Evans R. PCS-CF: A French-language, French-Canadian adaptation of the pain catastrophizing scale. Can J Behav Sci. 2005;37(3):181–92. doi: 10.1037/h0087255.
    1. Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524–32. doi: 10.1037/1040-3590.7.4.524.
    1. Gauthier J, Bouchard S. Adaptation canadienne-française de la forme révisée du state–trait anxiety inventory de Spielberger. [A French-Canadian adaptation of the revised version of Spielberger’s state–trait anxiety inventory.] Can J Behav Sci. 1993;25(4):559–78. doi: 10.1037/h0078881.
    1. Julian LJ. Measures of anxiety. Arthritis Care Res. 2011;63(0 11):10.1002/acr.20561. doi:10.1002/acr.20561.
    1. Stauder A, Kovacs M. Anxiety symptoms in allergic patients: identification and risk factors. Psychosom Med. 2003;65(5):816–23. doi: 10.1097/01.PSY.0000088620.66211.B1.
    1. Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corp; 1996.
    1. Bourque P, Beaudette D. Étude psychometrique du questionnaire de dépression de Beck auprès d’un échantillon d’étudiants universitaires francophones. [Psychometric study of the Beck Depression Inventory on a sample of French-speaking university students.] Can J Behav Sci. 1982;14(3):211–8. doi: 10.1037/h0081254.
    1. Coons MJ, Hadjistavropoulos HD, Asmundson GJ. Factor structure and psychometric properties of the pain anxiety symptoms scale-20 in a community physiotherapy clinic sample. Eur J Pain (London, England) 2004;8(6):511–6. doi: 10.1016/j.ejpain.2003.11.018.
    1. McCracken LM, Dhingra L. A short version of the pain anxiety symptoms scale (PASS-20): preliminary development and validity. Pain Res Manag. 2002;7(1):45–50. doi: 10.1155/2002/517163.
    1. Abrams MP, Carleton RN, Asmundson GJ. An exploration of the psychometric properties of the PASS-20 with a nonclinical sample. J Pain. 2007;8(11):879–86. doi: 10.1016/j.jpain.2007.06.004.
    1. Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58. doi: 10.1016/S0304-3959(01)00349-9.
    1. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther. 2004;27(1):26–35. doi: 10.1016/j.jmpt.2003.11.003.
    1. Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage. 2003;25(5):406–11. doi: 10.1016/S0885-3924(03)00162-3.
    1. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL. Defining the clinically important difference in pain outcome measures. Pain. 2000;88(3):287–94. doi: 10.1016/S0304-3959(00)00339-0.
    1. Borckardt JJ, Romagnuolo J, Reeves ST, Madan A, Frohman H, Beam W, et al. Feasibility, safety, and effectiveness of transcranial direct current stimulation for decreasing post-ERCP pain: a randomized, sham-controlled, pilot study. Gastrointest Endosc. 2011;73(6):1158–64. doi: 10.1016/j.gie.2011.01.050.
    1. Morin M, Dumoulin C, Bergeron S, Mayrand MH, Khalife S, Waddell G, et al. Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: design and methods. Contemp Clin Trials. 2016;46:52–9. doi: 10.1016/j.cct.2015.11.013.
    1. Neter J, Wasserman W, Kutner MH. Applied linear statistical models. Boston: Irwin; 1990.
    1. Liebetanz D, Nitsche MA, Tergau F, Paulus W. Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability. Brain. 2002;125(Pt 10):2238–47. doi: 10.1093/brain/awf238.
    1. Valeriani M, Restuccia D, Di Lazzaro V, Oliviero A, Profice P, Le Pera D, et al. Inhibition of the human primary motor area by painful heat stimulation of the skin. Clin Neurophysiol. 1999;110(8):1475–80. doi: 10.1016/S1388-2457(99)00075-9.
    1. Peyron R, Faillenot I, Mertens P, Laurent B, Garcia-Larrea L. Motor cortex stimulation in neuropathic pain: correlations between analgesic effect and hemodynamic changes in the brain: a PET study. Neuroimage. 2007;34(1):310–21. doi: 10.1016/j.neuroimage.2006.08.037.
    1. Garcia-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D, et al. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain. 1999;83(2):259–73. doi: 10.1016/S0304-3959(99)00114-1.
    1. Garcia-Larrea L, Peyron R. Motor cortex stimulation for neuropathic pain: from phenomenology to mechanisms. Neuroimage. 2007;37(Suppl 1):S71–9. doi: 10.1016/j.neuroimage.2007.05.062.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe