Is Vulvodynia a Sympathetically Maintained Pain?
The questions haunting the management of vulvar pain syndromes are still the most basic ones-what establishes these chronic pain loops and how are they maintained? The answers probably lie in considering vulvodynia as a sympathetically maintained pain (rather than a conventional somatic pain). the established model for such a phenomenon is a group of chronic pain syndrome(s) now known as reflex sympathetic dystrophy (RSD). hi essence, RSD is a combination-refractory, poorly localized pain and an exaggeration of the local inflammation.”‘ The first clinical example of an RSD was S. Wier Mitchell’s observations made on soldiers who suffered partial gunshot transections of major peripheral nerves during the American Civil War .67 Writing several decades before the autonomic nervous system had been defined, Mitchell recognized all of the essential elements: namely, (1) the burning nature of this pain; (2) spread beyond the distributions of the injured peripheral nerve; (3) the seemingly biz
