Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation

Defrin, Ruth; Schreiber, Shaul; Ginzburg, Karni

doi:10.1016/j.jpain.2015.06.010

Cited by 69 publications

(55 citation statements)

References 59 publications

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“…21,35 Psychological mechanisms underlying this process include exacerbated pain perception due to elevated anxiety level. 9 For instance, the development of chronic pain in patients with PTSD after severe accidents has been associated more strongly with PTSD symptoms than other accident-related variables, like the type of accident, or like the Injury Severity Score or Glasgow Coma Scale score immediately after the accident. 14,15 Others have proposed shared vulnerability underlying the comorbidity of PTSD and pain, 3 like the abnormal processing of threat cues.…”

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confidence: 99%

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder

Jenewein

Erni

Moergeli

et al. 2016

The Journal of Pain

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There is growing evidence that fear learning abnormalities are involved in the development of posttraumatic stress disorder (PTSD) and chronic pain. More than 50% of PTSD patients suffer from chronic pain. This study aimed to examine the role of fear-learning deficits in the link between pain perception and PTSD. We included 19 subjects with PTSD and 21 age- and sex-matched healthy control subjects in a fear-conditioning experiment. The conditioned stimulus (CS) consisted of visual signs flashed upon a screen in front of each subject. The unconditioned stimulus was either a low or high temperature impulse delivered through a thermal contact thermode on the subjects’ hand. A designation of ‘CS−’ was assigned to CS always followed by nonpainful low-temperature stimuli; a designation of ‘CS+’ was given to CS that were randomly followed by either a low or a more painful high temperature. Skin conductance was used as a physiological marker of fear. In healthy control subjects, CS+ induced more fear than CS−, and a low-temperature stimulus induced less subjective pain after CS− than after CS+. PTSD subjects failed to demonstrate such adaptive conditioning. Fear ratings after CS presentation were significantly higher in the PTSD group than in the control group. There were significant interaction effects between group and the type of CS on fear and pain ratings. Fear-learning deficits are a potentially promising, specific psychopathological factor in altered pain perception associated with PTSD. Deficits in safety learning may increase fear and, consequently, pain sensations. These findings may contribute to elucidating the pathogenesis behind the highly prevalent comorbidity that exists between PTSD and pain disorders, and to developing new treatments.

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confidence: 99%

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder

Jenewein

Erni

Moergeli

et al. 2016

The Journal of Pain

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“…Similar patterns occur in patients with chronic pain 41–43. Hyperalgesia was unlikely to be an artifact of QST administration because we used the same testers and same equipment in both ED and healthy volunteer cohorts.…”

Section: Discussionmentioning

confidence: 65%

Quantitative sensory testing measures individual pain responses in emergency department patients

Duffy

Flickinger

Kristan

et al. 2017

JPR

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BackgroundRefining and individualizing treatment of acute pain in the emergency department (ED) is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients.Materials and methodsIn three studies, we 1) describe performance characteristics of brief quantitative sensory testing (QST) in 50 healthy volunteers, 2) test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3) measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT), pressure pain response (PPR), and cold pain tolerance (CPT) tests.ResultsFirst, all QST measures had high inter-rater reliability and test–retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16%) ED subjects relative to healthy volunteers. In 173 (88%) ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen’s dz 0.10–0.19). Verbal pain scores (0–10) for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6) (Cohen’s dz 0.97) but did not covary with the changes in PPT and PPR (r=0.05–0.13). Treatment effects were greatest in ED subjects with a history of treatment for anxiety or depression (Cohen’s dz 0.26–0.43) or with baseline hyperalgesia (Cohen’s dz 0.40–0.88).ConclusionQST reveals individual differences in perception of fixed painful stimuli in ED patients, including hyperalgesia. Subgroups of ED patients with hyperalgesia and psychiatric history report larger treatment effects on ED pain and QST measures.

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“…[52][53][54]71 However, this was found in painful, previously tortured body regions, whereas we tested pain-free body regions not subjected to torture. Inconsistencies regarding pain threshold were also found among subjects with PTSD after other traumatic events, being higher, 14,16,20,26,40,68 lower, 18 or similar 58 to control subjects and also after psychological trauma without full-blown PTSD. 70 These inconsistencies may stem from the high between-and within-subjects' variability in pain threshold, the trauma inducing the PTSD and the sensory modality used.…”

Section: The Effect Of Traumamentioning

confidence: 87%

“…Although we could not find comparable studies on torture survivors, studies on PTSD participants have shown increased TSP 38 and increased pain ratings compared with control subjects. 14,16 Furthermore, Figure 2. The chronic PTSD group exhibits more pronounced TSP than all other groups; (delayed PTSD:^P = .05, PTSDresilient and healthy control subjects: **1 P < .01, each) and the delayed PTSD group had larger TSP than the PTSD-resilient and healthy control groups (*2 P < .05).…”

Section: The Effect Of Traumamentioning

confidence: 97%

“…25 Apart from the association of PTSD and chronic pain, 5,61 PTSD among trauma survivors has also been associated with altered pain perception including changes in the sensitivity and reactivity to painful stimuli. 14,16,20,26,32 Thus, the presence or absence of PTSD among torture survivors may mediate the alterations observed in their pain system. Importantly, PTSD symptoms tend to wax and wane over time.…”

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confidence: 99%

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Dysfunctional Pain Modulation in Torture Survivors: The Mediating Effect of PTSD

Defrin

Lahav

Solomon

2017

The Journal of Pain

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Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation

Cited by 69 publications

References 59 publications

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder

Quantitative sensory testing measures individual pain responses in emergency department patients

Dysfunctional Pain Modulation in Torture Survivors: The Mediating Effect of PTSD

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