11 research outputs found
The role of pain modulation in non-suicidal self-injury
Individuals with non-suicidal self-injury (NSSI) behavior tend to report feeling little or no
pain when they self-injure. Moreover, in laboratory studies the NSSI population tends to
demonstrate reduced sensitivity to painful stimuli. There is reason to believe that hypoalgesia
could be a risk factor for developing and maintaining NSSI. Many theories have been
proposed to explain the reduced sensitivity to pain in the NSSI population; some examples
are dissociation, self-critical cognitive style, and low levels of endogenous opioids. However,
the evidence supporting these theories are sparse. To understand why the NSSI population
experiences less pain, there is a need for a better understanding of how individuals with NSSI
process pain. We wanted to use methods that have been developed to study pain modulation
in individuals with long-term pain to characterize the pain modulation system of women with
ongoing NSSI. Our general hypothesis was that women with NSSI have a hyper-effective
pain modulation system that inhibits pain to a greater extent and facilitates pain to a lesser
extent, compared to women without NSSI.
In Study I, a non-clinical population (N = 62) was recruited to test a pain testing protocol in
order to produce offset analgesia (OA) and onset hyperalgesia (OH). Small deviations in a
painful thermal stimulation have been found to produce disproportional hypoalgesic (OA)
and hyperalgesic (OH) responses. Different stimulus ranges (±1°C and ±2°C) were included
in the protocol to study the dynamic relation between heat and pain. The study was composed
of two identical experiments. In experiment 1, we produced OA and OH responses, using
±2°C but not ±1°C. In experiment 2, we only produced OA responses, but no OH responses.
Study II investigated if it was possible to induce sensory attenuation of pain in a non-clinical
population (N = 40) by comparing self-administered pressure pain threshold to experimenteradministrated
pressure pain threshold, using an algometer. An experimental condition, where
the participants imagined that they pressed the algometer, was also included in the study, to
examine if sensory attenuation could be induced with the help of imagery. Self-administered
pressure was found to be less painful, compared to experimenter-administered pressure.
Moreover, imagined self-administered pressure was also experienced as less painful than
experimenter-administered pressure. Self-induced sensory attenuation of pain could be a
factor in explaining hypoalgesia during NSSI.
Study III consisted of an extensive battery of pain tests in order to study pain modulation in
a sample of women with NSSI (N = 41) and an age-matched control group, consisting of
healthy women (N = 40). The study also included a simple pain test combined with fMRI.
We found that the NSSI group demonstrated higher pressure and heat pain thresholds,
compared to the control group. The NSSI group also demonstrated a larger conditioned pain
modulation (CPM) effect, compared to the control group. CPM is a test based on the principle
pain inhibits pain, and is a measure of central down-regulation of pain. We found no
difference between the groups regarding temporal summation of pain, a measure of pain
facilitation, or in heat pain tolerance. Tonic painful heat stimulation produced a larger
hemodynamic response in primary and secondary somatosensory cortex in the NSSI group,
compared to the control group.
In Study IV, we used the combined OA/OH protocol that was evaluated in Study I to study
pain modulation in women with NSSI (N = 37) and controls (N = 39). The OA/OH protocol
was combined with fMRI. Across groups, both the OA and the OH responses were
significant. We also found a difference between the groups regarding the OH response, as
the NSSI group demonstrated a weaker OH response, compared to the control group. The
OH response was associated with a hemodynamic response in the primary somatosensory
cortex, across groups, which suggests that the nociceptive signal was upregulated before
reaching the brain.
In line with our main hypothesis, we found that the NSSI group inhibited pain to a greater
extent (CPM in Study III) and facilitated pain to a lesser extent (OH in Study IV), compared
to the control group. These results suggest that women with NSSI have a hyper-effective pain
modulation system. There were also results that did not support our main hypothesis; the
NSSI group did not demonstrate weaker pain facilitation when tested with the temporal
summation protocol (Study III) or stronger inhibition associated with OA (Study IV). An
explanation could be that different pain tests measure different aspects of pain modulation
and only certain pain modulation mechanisms are affected in the NSSI population. The
studies of this thesis provide evidence that the previous findings of hypoalgesia in the NSSI
population does not reflect response bias but is rooted in how the nervous system modulates
nociceptive signals
FoÌrstapersonsbeskrivningar och foÌrstapersonsmetoder i Francisco Varelas neurofenomenologiska forskningsprogram
The present paper critically examines the epistemic status of first-person accounts and first-person methods in Francisco Varelaâs research program neurophenomenology, which integrates a phenomenological perspective in cognitive science. The paper also questions Varelaâs description of neurophenomenology as an ontological recategorization of nature and a solution to the hard problem of consciousness
The difference between externally and self-administered pain in patients with non-suicidal self-injury behavior
The association between body plasticity, dissociation trait, and pain sensitivity in patients with non-suicidal self-injury behavior
Cognitive behaviour therapy for depression in primary care: systematic review and meta-analysis
Rubber hand illusion and experiences of dissociation in women with self-injury behavior
Background: Illusory ownership over a rubber limb, as observed in the experimental paradigm the rubber hand illusion (RHI), has been reported to be correlated with self-reported dissociative symptoms in patients with current and remitted borderline personality disorder. The aim of the present study was to assess the association between RHI and dissociative symptoms in women with non-suicidal self-injury (NSSI), a patient group reporting high levels of dissociative symptoms. Methods: 41 women with NSSI and a healthy control group of 40 women were included in the study. The RHI was induced by administering tactile stimulation with a soft brush to the participantsâ hand and a rubber hand. One congruent condition (synchronous brushing) and one incongruent condition (asynchronous brushing) was compared. The strength of the illusion was measured with the RHI questionnaire and proprioceptive drift. Trait dissociation was measured with the Dissociative Experience Scale-II. Results: Both the NSSI group (p < .001) and control group (p < .001) reported illusory ownership during the experiment, but there was no statistically significant difference in illusory ownership (p = .694) or proprioceptive drift (p = .219) between NSSI and controls. Illusory ownership did not correlate with trait dissociation symptoms in the NSSI group. Discussion: The RHI was induced in both groups but was not more pronounced in NSSI and did not correlate with dissociative symptoms. The results are consistent with some of the previous efforts to establish a relationship between illusory ownership and borderline personality disorder
Placebo response and media attention in randomized clinical trials assessing cannabis-based therapies for pain: a systematic review and meta-analysis.
IMPORTANCE
Persistent pain is a common and disabling health problem that is often difficult to treat. There is an increasing interest in medicinal cannabis for treatment of persistent pain; however, the limited superiority of cannabinoids over placebo in clinical trials suggests that positive expectations may contribute to the improvements.
OBJECTIVE
To evaluate the size of placebo responses in randomized clinical trials in which cannabinoids were compared with placebo in the treatment of pain and to correlate these responses to objective estimates of media attention.
DATA SOURCES
A systematic literature search was conducted within the MEDLINE and Embase databases. Studies published until September 2021 were considered.
STUDY SELECTION
Cannabinoid studies with a double-blind, placebo-controlled design with participants 18 years or older with clinical pain of any duration were included. Studies were excluded if they treated individuals with HIV/AIDS or severe skin disorders.
DATA EXTRACTION AND SYNTHESIS
The study followed the Preferred Reporting Items for Systematic Review and Meta-analyses reporting guideline. Data were extracted by independent reviewers. Quality assessment was performed using the Risk of Bias 2 tool. Attention and dissemination metrics for each trial were extracted from Altmetric and Crossref. Data were pooled and analyzed using a random-effects statistical model.
MAIN OUTCOMES AND MEASURES
Change in pain intensity from before to after treatment, measured as bias-corrected standardized mean difference (Hedges g).
RESULTS
Twenty studies, including 1459 individuals (mean [SD] age, 51 [7] years; age range, 33-62 years; 815 female [56%]), were included. Pain intensity was associated with a significant reduction in response to placebo, with a moderate to large effect size (mean [SE] Hedges g, 0.64 [0.13]; Pâ<â.001). Trials with low risk of bias had greater placebo responses (q1â=â5.47; I2â=â87.08; Pâ=â.02). The amount of media attention and dissemination linked to each trial was proportionally high, with a strong positive bias, but was not associated with the clinical outcomes.
CONCLUSIONS AND RELEVANCE
Placebo contributes significantly to pain reduction seen in cannabinoid clinical trials. The positive media attention and wide dissemination may uphold high expectations and shape placebo responses in future trials, which has the potential to affect the outcome of clinical trials, regulatory decisions, clinical practice, and ultimately patient access to cannabinoids for pain relief
Augmented pain inhibition and higher integration of pain modulatory brain networks in women with self-injury behavior
Individuals who engage in nonsuicidal self-injury (NSSI) have demonstrated insensitivity to pain compared with individuals without NSSI. Yet, the neural mechanisms behind this difference are unknown. The objective of the present study was to determine which aspects of the pain regulatory system that account for this decreased sensitivity to pain. In a case-control design, 81 women, aged 18-35 (mean [SD] age, 23.4 [3.9]), were included (41 with NSSI and 40 healthy controls). A quantitative sensory testing protocol, including heat pain thresholds, heat pain tolerance, pressure pain thresholds, conditioned pain modulation (assessing central down-regulation of pain), and temporal summation (assessing facilitation of pain signals) was used. Pain-evoked brain responses were assessed by means of fMRI scanning during thermal pain. NSSI participants showed a more effective central down-regulation of pain, compared to controls, assessed with conditioned pain modulation. The neural responses to painful stimulation revealed a stronger relation between nociceptive and pain modulatory brain regions in NSSI compared to controls. In line with previous studies, pressure and heat pain thresholds were higher in participants with NSSI, however, there were no correlations between pain outcomes and NSSI clinical characteristics. The augmented pain inhibition and higher involvement of pain modulatory brain networks in NSSI may represent a pain insensitive endophenotype associated with a greater risk for developing self-injurious behavior