Changes in self-reported disability after performance-based tests in obese and non-obese individuals diagnosed with osteoarthritis of the knee

Purpose: The purposes of this study are three-fold: (1) To examine whether the WOMAC questionnaire should be obtained before or after performance-based tests. (2) To assess whether self-reported disability scores before and after performance-based tests differ between obese and non-obese individuals. (3) To observe whether physical activity and BMI predict self-reported disability before and after performance based tests. Methods: A longitudinal study included thirty one participants diagnosed with knee osteoarthritis (OA) using the Kellgren-Lawrence Scale by an orthopedic surgeon. Results: All WOMAC scores were significantly higher after as compared to before the completion of performance-based tests. This pattern of results suggested that the WOMAC questionnaire should be administered to individuals with OA after performance-based tests. The obese OA was significantly different compared to the non-obese OA group on all WOMAC scores. Physical activity and BMI explained a significant proportion of variance of self-reported disability. Conclusion: Obese individuals with knee OA may over-estimate their ability to perform physical activities, and may under-estimate their level of disability compared to non-obese individuals with knee OA. In addition, self-reported physical activity seems to be a strong indicator of disability in individuals with knee OA, particularly for individuals with a sedentary life style

Predictors of psychosocial and functional outcomes in Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Application of the fear avoidance model

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD), which affects up to 4.3% of individuals, is a distressing and poorly understood condition characterized by persistent, unwanted, and often painful sensations of genito-pelvic arousal (e.g., throbbing) in the absence of sexual desire. PGAD/GPD is associated with significant negative impacts on psychosocial wellbeing and daily functioning. Recent research has indicated that PGAD/GPD shares many similarities with other forms of chronic genito-pelvic pain. This study applied the Fear Avoidance (FA) Model of chronic pain to PGAD/GPD to identify cognitive and behavioral factors associated with psychosocial and functional outcomes. A total of 263 individuals with PGAD/GPD symptoms completed a cross-sectional online survey of symptom intensity, cognitive and behavioral predictors (symptom catastrophizing, hypervigilance to symptoms, symptom fear and avoidance, self-efficacy), depression symptoms, and role functioning. Symptom catastrophizing, fear of symptoms, avoidance of symptoms, and hypervigilance to PGAD/GPD symptoms were significantly correlated with poorer psychosocial and functional outcomes, whereas higher self-efficacy was significantly associated with lower depression and better role functioning. Two serial parallel mediation models examined the fear avoidance pathway from PGAD/GPD symptom intensity to depression symptoms and role functioning. In both models, the pathway through symptom catastrophizing, fear of symptoms, and symptom avoidance was significant, but the pathway through symptom catastrophizing, fear of symptoms, and symptom hypervigilance was not. The results of this study provide support for the applicability of the FA Model to PGAD/GPD. Interventions targeting fear avoidance factors may help to reduce PGAD/GPD symptom intensity, distress, and increase psychological wellbeing and daily functioning

Distinct neural signaling characteristics between fibromyalgia and provoked vestibulodynia revealed by means of functional magnetic resonance imaging in the brainstem and spinal cord

IntroductionFibromyalgia and provoked vestibulodynia are two chronic pain conditions that disproportionately affect women. The mechanisms underlying the pain in these conditions are still poorly understood, but there is speculation that both may be linked to altered central sensitization and autonomic regulation. Neuroimaging studies of these conditions focusing on the brainstem and spinal cord to explore changes in pain regulation and autonomic regulation are emerging, but none to date have directly compared pain and autonomic regulation in these conditions. This study compares groups of women with fibromyalgia and provoked vestibulodynia to healthy controls using a threat/safety paradigm with a predictable noxious heat stimulus.MethodsFunctional magnetic resonance imaging data were acquired at 3 tesla in the cervical spinal cord and brainstem with previously established methods. Imaging data were analyzed with structural equation modeling and ANCOVA methods during: a period of noxious stimulation, and a period before the stimulation when participants were expecting the upcoming pain.ResultsThe results demonstrate several similarities and differences between brainstem/spinal cord connectivity related to autonomic and pain regulatory networks across the three groups in both time periods.DiscussionBased on the regions and connections involved in the differences, the altered pain processing in fibromyalgia appears to be related to changes in how autonomic and pain regulation networks are integrated, whereas altered pain processing in provoked vestibulodynia is linked in part to changes in arousal or salience networks as well as changes in affective components of pain regulation

Online pelvic floor group education program for women with persistent genital arousal disorder/genito-pelvic dysesthesia: Descriptive feasibility study

Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants’ abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms

Healthcare experiences of individuals with persistent genital arousal disorder/genito-pelvic dysesthesia

ntroduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent, unwanted sensations of genital arousal (eg, feelings of being on the verge of orgasm, and of lubrication, swelling, tingling, throbbing) that occur in the absence of sexual desire. Although PGAD/GPD is associated with significant impairments in psychosocial functioning, the healthcare (HC) experiences of affected individuals are not well understood. Aim The aims of this study were to examine the barriers to HC, the costs of HC, and the associations among HC experiences, symptoms, and psychosocial outcomes in those with PGAD/GPD symptoms. Methods One hundred and thirteen individuals with PGAD/GPD symptoms completed an online, cross-sectional self-report questionnaire about their HC history and experiences. Main Outcome Measures Self-reported HC barriers, and financial costs associated with PGAD/GPD HC. Validated measures of HC experiences (eg, comfort communicating with HC practitioners [HCPs]), and psychosocial (eg, depression, anxiety) and PGAD/GPD symptom outcomes. Results The majority of participants (56.6%) reported waiting at least 6 months to seek HC for PGAD/GPD symptoms. Those who sought HC approached many HCPs (46.0% approached 6+ HCPs). Several barriers to HC were identified (eg, lack of HCP knowledge of PGAD/GPD), and high costs were reported. A series of multiple linear regression analyses found an association between HC experiences, psychosocial, and symptom outcomes. Specifically, decreased comfort communicating with one's HCP was associated with greater depressive and anxiety symptoms. Conclusion High costs and numerous barriers to seeking HC for PGAD/GPD symptoms were identified, and discomfort communicating with an HCP about PGAD/GPD was associated with increased symptoms of depression and anxiety. These results highlight the need for more awareness of this condition in order to improve care for this population

How to Read a Visualization Research Paper: Extracting the Essentials

Introduction. Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. Aim. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. Methods. An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. Main Outcome Measure. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. Conclusions. Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches. van Lankveld JJDM, Granot M, Weijmar Schultz WCM, Binik YM, Wesselmann U, Pukall CF, Bohm-Starke N, and Achtrari C. Women's sexual pain disorders. J Sex Med 2010;7:615-631

International Society for the Study of Women's Sexual Health (ISSWSH) review of epidemiology and pathophysiology, and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD)

Background Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed

Understanding vulvar vestibulitis syndrome through pain measurement : applications of multidimensional pain methodologies and development of novel assessment techniques

Vulvar vestibulitis syndrome is a highly prevalent and under-investigated pain syndrome. It is believed to be the most common form of dyspareunia, or painful intercourse, in pre-menopausal women. Despite the fact that pain is its defining characteristic, its conceptualization as a sexual dysfunction remains the predominant view. The first chapter of this thesis reviews support for a re-conceptualization of vulvar vestibulitis as a pain disorder, and contends that the pain component must be measured as it is in chronic pain patients, both objectively and subjectively. This paper is followed by a study in which tactile and pain thresholds in genital and non-genital body areas of 13 women with vulvar vestibulitis syndrome and 13 non-affected women were measured, while data about the intensity and unpleasantness of these sensations were collected. Results indicated that women with vulvar vestibulitis have decreased tactile and pain thresholds in both genital and non-genital body areas, as well as higher unpleasantness ratings in response to painful stimuli than controls, replicating data from the chronic pain literature. The third paper presents a pain conceptualization of vulvar vestibulitis according to classification criteria used by the International Association for the Study of Pain, and introduces the development of a vulvalgesiometer, a standardized method of genital pain measurement. Data collected with the vulvalgesiometer are presented in the fourth paper, a study in which 14 women with vulvar vestibulitis and 14 control women participated. Women with vulvar vestibulitis had significantly lower pain thresholds, higher pain unpleasantness ratings, and used adjectives similar to those reported during intercourse in response to painful stimulation. The vulvalgesiometer was used to elicit genital tactile and pain sensation in the two groups while brain activation patterns were measured via functional magnetic rdsonance imaging, the focus of the fifth paper. Results demonstrated that women with vulvar vestibulitis have augmentations of brain activity in the processing of both painful and non-painful genital stimulation as compared with non-affected women. Overall, findings from these studies suggest that the pain of vulvar vestibulitis can be reliably measured and that the pain perspective has important implications for both research and treatment of urogenital pain problems

Developing an Inclusive and Holistic Measure of Sexuality

The development of an inclusive and holistic measure of sexuality that can be used to assess the construct inclusively in individuals with diverse sexual and gender/sex identities and partner configurations. The constructs of sexuality measured will be informed by our lab's current "What is Sexuality" study, previous literature, and expert informants. The item pool will be developed in accordance with best practices for sexuality measure development. We will be using the PROMIS guidelines as a framework that will involve focus groups and interviews to gain input on the measure of those in sexual and gender/sex minority and majority groups