Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom—a Matched Case–Control Study

Abstract

Objective Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8–20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. Design We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. Results There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. Conclusions The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.

Leptin promoter methylation in female patients with painful multisomatoform disorder and chronic widespread pain

“…Diagnostic criteria for MSD according to the Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) were fulfilled by all patients. As previously reported, there were no differences between gender and age ( p > 0.05) (control group: mean age, 52.1 ± 9.9 years; 73% women and 27% men; MSD group: mean age, 54.4 ± 10.1 years; 82% women and 18% men) [ 6 – 9 , 21 ]. As expected the physical component summary score of the SF-36 demonstrated a significant difference between patients and controls (28.75 ± 7.81 vs 54.0 ± 5.74) ( p < 0.0001).…”

“…In a population-based twin study, genetic influences have been shown to play a role especially in painful FSS, whereas inconsistent results suggest a role of single nucleotide polymorphisms (SNPs) of serotonergic and dopaminergic genes [ 6 – 8 ]. Our group recently demonstrated common sensory alterations through quantitative sensory testing in patients with MSD [ 9 ] similar to those found in patients with fibromyalgia (FMS) [ 10 , 11 ]. In this context, the construct of chronic widespread pain is of particular interest.…”

“…Participants in this study have been previously evaluated with regards to the presence of SNPs of different genes [ 6 – 8 ], the presence of sensory alterations using standardized quantitative sensory testing as well as methylation status of the TRPA1 promoter [ 9 , 21 ]. Altogether, 151 MSD patients and 149 healthy controls were included in the study.…”

Neurohumoral Profiles and Childhood Adversity of Patients with Multisomatoform Disorder and Pain as the Leading Bodily Symptom

“…Subjects. The patient collective was previously investigated regarding the role of single nucleotide polymorphisms [6][7][8] as well as the difference in quantitative sensory profiles and epigenetic regulation of TRPA1 expression between patients and controls [9,11]. Altogether, 300 individuals were recruited to participate (151 patients, 149 controls).…”

“…Previous studies suggest a role of SNPs in serotonergic and dopaminergic but not catecholamine-o-transferase genes in the etiology of MSD [6][7][8]. Patients with MSD and pain as the leading bodily symptom show characteristic sensory alterations as demonstrated through quantitative sensory measurements [9]. In human physiology, a complex interplay between an acute and chronic response to stress, hormonal regulation of homoeostasis, and neurotrophic factors exists.…”