Pain and self-harm: A systematic review

Abstract

BackgroundA growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however, is inconsistent such that the nature of the relationship is unclear, and whether or not this effect is also present in suicidal self-harm is equivocal. MethodsA keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of Knowledge) was conducted, yielding 1,873 records. Following duplicate removal and screening, 25 articles were quality assessed, and included in the final systematic review. ResultsThere is strong evidence for increased pain tolerance in NSSI, and some evidence for this in suicidal individuals, but notably, there were no prospective studies. The review found a lack of substantive focus on psychological correlates of altered pain tolerance in this population. Several candidate explanatory mechanisms were proposed within the reviewed studies. LimitationsThe current review was a narrative systematic review; methods used to assess pain were considered too heterogeneous to conduct a meta-analysis. ConclusionsThe evidence suggests that there is elevated pain tolerance among those who engage in NSSI. Future prospective research should determine if altered pain tolerance is a cause or a consequence of the behaviour. The identification of psychological correlates of increased pain tolerance is a neglected area of research. It could provide opportunities for treatment/intervention development, if mediating or moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to draw definitive conclusions.

How Do Young People Understand Their Own Self-Harm? A Meta-synthesis of Adolescents’ Subjective Experience of Self-Harm

“…From laboratory studies, we know that people who selfharm display elevated physiological arousal in response to stressors, discontinue or escape stressful tasks sooner, and report greater efforts to suppress aversive thoughts and feelings during their day (Nock 2009). Research on physiological and neurobiological factors, such as pain endurance Kirtley et al 2016) and impulse-control , and on genetic influence (Althoff et al 2012;, is of importance to gain further knowledge of the phenomenon of self-harm at a group level.…”

“…Self-harm and pain-tolerance. In a review of studies of physical pain-tolerance among people who self-harm, Kirtley, O'Carroll and O'Connor (2016) found that people who selfharm report altered physical pain threshold and tolerance. However, it is not clear if altered pain tolerance among those who engage in self-harm is a cause or a consequence of the behavior.…”

Decreased Neural Response to Threat Differentiates Patients Who Have Attempted Suicide From Nonattempters With Current Ideation

“…There is a small body of work examining pain tolerance using behavioral measures such as the cold pressor task, thermal pain, electric shocks, or pressure algometers, predominantly among those with and without nonsuicidal self-injury (e.g., Franklin, Hessel, & Prinstein, 2011; Weinberg & Klonsky, 2012). As described in a recent review, this literature generally finds that those with a history of nonsuicidal self-injury have a higher pain threshold and tolerance than those without (Kirtley, O’Carroll, & O’Connor, 2016). However, behavioral measures of pain tolerance have yet to be used to compare suicide ideators to attempters.…”

Adolescent self-harm: think before prescribing

“…The self-verification concept proposes self-harm communicates adolescents’ negative views about themselves to others. Accordingly, self-harm is best seen as a heterogeneous phenomenon with complex internal and external factors 4…”