Natural History of Comorbid Orofacial Pain Among Women With Vestibulodynia

Abstract

Objectives We evaluated the stability of the comorbidity between vulvodynia and orofacial pain (OFP) and its associated clinical characteristics over a two-year follow up period. Methods In an earlier study of vestibulodynia patients, we administered questionnaires assessing demographic data, self-reported pain, anxiety, somatic awareness, and presence of signs and symptoms suggestive of clinical and subclinical OFP. The present study readministered the same surveys to a subset of the original cohort after a two-year follow up period. Results Of the 138 women in the previous study, 71 (51%) agreed to participate in the present study. We confirmed our earlier findings that 1) orofacial pain is a highly prevalent (66%) condition among women with vestibulodynia, and 2) compared to women with no OFP symptoms, those with OFP symptoms experience higher levels of anxiety (P=0.005), and somatic awareness (P<0.001). While OFP symptoms showed improvement in many of the vestibulodynia patients (33%) with OFP symptoms at baseline, 13% had either developed new symptoms or transitioned from subclinical to clinical OFP classification. Intercourse-related pain decreased in 69% of patients and increased in 24% of patients. Consistent with our earlier report, we did not observe significant differences with respect to demographics or severity of pain during intercourse among the subgroups. Discussion Orofacial pain is a common comorbidity among women with vestibulodynia, although the presence of OFP can vary over time. The comborbidity between vestibulodynia and OFP suggests that common underlying mechanisms may mediate both conditions.

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“…Common experience suggests human pain from tissue injury or threat may be continuous from the onset. Where it is acknowledged that there are continuous pattern pain syndromes such as fibromyalgia or temporomandibular dysfunction, provocable or non‐continuous patterns may also occur including overlaps of symptoms across different tissues and body sites . In this context, a vernacular description of migraine could be “a chronic recurrent disorder” where headache attacks are usually but not always similar in description, and headache free intervals of varying duration are the norm.…”

“…Where it is acknowledged that there are continuous pattern pain syndromes such as fibromyalgia or temporomandibular dysfunction, provocable or non-continuous patterns may also occur including overlaps of symptoms across different tissues and body sites. 13 In this context, a vernacular description of migraine could be "a chronic recurrent disorder" where headache attacks are usually but not always similar in description, and headache free intervals of varying duration are the norm. Even in chronic migraine, clinicians may expect headache free days and clinical trial designs emphasized the need for discrete days and headache free time, eg, topiramate 14,15 and botulinum toxin type A.…”

Vulvodynia—It Is Time to Accept a New Understanding from a Neurobiological Perspective

“…These associated factors include many different symptoms and frequent comorbidity in the pelvic area such as urological or coloproctological pain syndromes, pain syndrome associated with endometriosis, and irritable bowel syndrome, but also in remote areas such as orofacial pain or fibromyalgia [ 14 , 15 , 16 , 17 , 18 , 19 ]. The association of these factors with vulvodynia suggests that this entity is the expression of similar underlying pathophysiological processes [ 3 ].…”

Pain, Anxiety, Depression, and Quality of Life in Patients with Vulvodynia

“…It is associated with an increase in the density of C-fibre nerve endings in the vestibular endoderm in women with PVD, mostly identified as nociceptors [12]. It has been linked to several comorbid conditions such as interstitial cystitis, orofacial pain, fibromyalgia, and irritable bowel syndrome, with fibromyalgia and irritable bowel syndrome being the most common [13][14][15]. The central nervous system is also involved with augmented neural activity in response to painful vestibular stimulation in somatosensory, insular, and anterior cingulate regions [16].…”