Neuronale Korrelate unangenehmer somatosensorischer Stimulation bei Patienten mit Borderline-Persönlichkeitsstörung und Depression

ZUSAMMENFASSUNG

Das Empfinden von unangenehmen Reizen, wie auch die Schmerzempfindung im engeren Sinne, wird nicht nur durch rein somatosensorische und nozizeptive Informationen, sondern ebenso durch affektive und kognitive Prozesse moduliert. Klinische Beobachtungen sowie wissenschaftliche Untersuchungen belegen eine veränderte Wahrnehmung der Schmerzempfindung bei psychischen Erkrankungen wie beispielsweise der emotional-instabilen Persönlichkeitsstörung vom Borderline-Typ (BPS) oder bei depressiven Störungen (MD). Die Untersuchung der verschiedenen Modalitäten der Schmerzverarbeitung, welche zu einem großen Teil mit der Verarbeitung unangenehmer Reize überlappt, ist mittels verschiedener Stimulationsparadigmen möglich. Für die Darstellung der zugrunde liegenden neurofunktionellen Mechanismen eignet sich die funktionelle Magnetresonanztomografie (fMRT). Unter experimentellen Bedingungen kann der somatosensorisch-diskriminative Aspekt der Verarbeitung und Wahrnehmung von Schmerz und unangenehmen Reizen mit einem elektrischen Stimulationsparadigma operationalisiert werden. Die neuronalen Korrelate unangenehmer somatosensorischer Stimulation bei Patienten mit BPS und MD werden anhand eigener fMRT-Untersuchungen dargestellt und die veränderte Schmerzverarbeitung der beiden klinischen Gruppen erörtert.

ABSTRACT

The sensation of unpleasant stimulation and pain is not only modulated by somatosensory and nociceptive information, but also by affective and cognitive processes. Clinical observations and previous studies suggested alterations in pain perception in psychiatric diseases such as Borderline Personality Disorder (BPD) or major depression (MD). Different modalities of pain processing, which largely overlap with the processing of unpleasant stimulation, can be assessed by different stimulation paradigms. Functional magnetic resonance imaging (fMRI) is suitable for the investigation of the underlying neurofunctional mechanisms. Under experimental conditions, the somatosensory discriminative aspect of processing and perception of pain and unpleasantness can be operationalized with an electrical stimulation paradigm. We investigated neuronal correlates of unpleasant somatosensory stimulation in patients with BPD and MD by fMRI and alterations in pain processing are discussed.

Publication History

Article published online:
04 February 2021

• Literatur

• 1 Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986; 3: S1-226 https://pubmed.ncbi.nlm.nih.gov/3461421/
• 2 Peters ML. Emotional and Cognitive Influences on Pain Experience. Mod Trends Pharmacopsychiatry 2015; 30: 138-152
• 3 Bohus M, Limberger M, Ebner U. et al Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res 2000; 95: 251-260
• 4 Schmahl C, Bohus M, Esposito F. et al Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry 2006; 63: 659-667
• 5 Ludascher P, Bohus M, Lieb K. et al Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res 2007; 149: 291-296
• 6 Ludascher P, Bohus M, Lieb K. et al Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res 2007; 149: 291-296 DOI: 10.1016/j.psychres.2005.04.009.
• 7 Schmahl C, Greffrath W, Baumgartner U. et al Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain 2004; 110: 470-479 DOI: 10.1016/j.pain.2004.04.035.
• 8 Cardenas-Morales L, Fladung AK, Kammer T. et al Exploring the affective component of pain perception during aversive stimulation in borderline personality disorder. Psychiatry Res 2011; 186: 458-460 DOI: 10.1016/j.psychres.2010.07.050.
• 9 Adler G, Gattaz WF. Pain perception threshold in major depression. Biol Psychiatry 1993; 34: 687-689 DOI: 10.1016/0006-3223(93)90041-b.
• 10 Bar KJ, Brehm S, Boettger MK. et al Pain perception in major depression depends on pain modality. Pain 2005; 117: 97-103 DOI: 10.1016/j.pain.2005.05.016.
• 11 Bar KJ, Greiner W, Letsch A. et al Influence of gender and hemispheric lateralization on heat pain perception in major depression. J Psychiatr Res 2003; 37: 345-353 DOI: 10.1016/s0022-3956(03)00051-7.
• 12 Schwier C, Kliem A, Boettger MK. et al Increased cold-pain thresholds in major depression. J Pain 2010; 11: 287-290 DOI: 10.1016/j.jpain.2009.07.012.
• 13 Lautenbacher S, Spernal J, Schreiber W. et al Relationship between clinical pain complaints and pain sensitivity in patients with depression and panic disorder. Psychosom Med 1999; 61: 822-827 DOI: 10.1097/00006842-199911000-00015.
• 14 Dickens C, McGowan L, Dale S. Impact of depression on experimental pain perception: a systematic review of the literature with meta-analysis. Psychosom Med 2003; 65: 369-375 DOI: 10.1097/01.psy.0000041622.69462.06.
• 15 Leibenluft E, Gardner DL, Cowdry RW. The inner experience of the borderline self-mutilator. Journal of Personality Disorders 1987; 1: 317-324 DOI: 10.1521/pedi.1987.1.4.317.
• 16 Wager TD, Atlas LY, Lindquist MA. et al An fMRI-based neurologic signature of physical pain. N Engl J Med 2013; 368: 1388-1397 DOI: 10.1056/NEJMoa1204471.
• 17 Rainville P, Duncan GH, Price DD. et al Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 1997; 277: 968-971 DOI: 10.1126/science.277.5328.968.
• 18 Peyron R, Laurent B, Garcia-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin 2000; 30: 263-288 DOI: 10.1016/s0987-7053(00)00227-6.
• 19 Davis KD. The neural circuitry of pain as explored with functional MRI. Neurol Res 2000; 22: 313-317 DOI: 10.1080/01616412.2000.11740676.
• 20 Tan LL, Pelzer P, Heinl C. et al A pathway from midcingulate cortex to posterior insula gates nociceptive hypersensitivity. Nat Neurosci 2017; 20: 1591-1601 DOI: 10.1038/nn.4645.
• 21 Buchel C, Bornhovd K, Quante M. et al Dissociable neural responses related to pain intensity, stimulus intensity, and stimulus awareness within the anterior cingulate cortex: a parametric single-trial laser functional magnetic resonance imaging study. J Neurosci 2002; 22: 970-976
• 22 Vogt BA. Midcingulate cortex: Structure, connections, homologies, functions and diseases. J Chem Neuroanat 2016; 74: 28-46 DOI: 10.1016/j.jchemneu.2016.01.010.
• 23 Adolph O, Koster S, Georgieff M. et al Xenon-induced changes in CNS sensitization to pain. Neuroimage 2010; 49: 720-730 DOI: 10.1016/j.neuroimage.2009.08.034.
• 24 Malejko K, Neff D, Brown RC. et al Somatosensory Stimulus Intensity Encoding in Borderline Personality Disorder. Front Psychol 2018; 9: 1853 DOI: 10.3389/fpsyg.2018.01853.
• 25 Bonenberger M, Plener PL, Groschwitz RC. et al Polymorphism in the micro-opioid receptor gene (OPRM1) modulates neural processing of physical pain, social rejection and error processing. Exp Brain Res 2015; 233: 2517-2526 DOI: 10.1007/s00221-015-4322-9.
• 26 Malejko K, Brown RC, Plener PL. et al Differential neural processing of unpleasant sensory stimulation in patients with major depression. Eur Arch Psychiatry Clin Neurosci 2020 DOI: 10.1007/s00406-020-01123-0
• 27 Bonenberger M, Plener PL, Groschwitz RC. et al Differential neural processing of unpleasant haptic sensations in somatic and affective partitions of the insula in non-suicidal self-injury (NSSI). Psychiatry Res 2015; 234: 298-304 DOI: 10.1016/j.pscychresns.2015.10.013.
• 28 Petersen-Felix S, Arendt-Nielsen L. From pain research to pain treatment: the role of human experimental pain models. Best Pract Res Clin Anaesthesiol 2002; 16: 667-680 DOI: 10.1053/bean.2002.0258.
• 29 Bair MJ, Robinson RL, Katon W. et al Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163: 2433-2445
• 30 Breivik H, Collett B, Ventafridda V. et al Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10: 287-333
• 31 Al-Alem L, Omar HA. Borderline personality disorder: an overview of history, diagnosis and treatment in adolescents. Int J Adolesc Med Health 2008; 20: 395-404
• 32 Kleindienst N, Bohus M, Ludascher P. et al Motives for nonsuicidal self-injury among women with borderline personality disorder. J Nerv Ment Dis 2008; 196: 230-236 DOI: 10.1097/NMD.0b013e3181663026.
• 33 Shearer SL. Phenomenology of self-injury among inpatient women with borderline personality disorder. J Nerv Ment Dis 1994; 182: 524-526
• 34 Willis F, Kuniss S, Kleindienst N. et al Stress reactivity and pain-mediated stress regulation in remitted patients with borderline personality disorder. Brain Behav 2018; 8: e00909 DOI: 10.1002/brb3.909.
• 35 Biskin RS, Frankenburg FR, Fitzmaurice GM. et al Pain in patients with borderline personality disorder. Personal Ment Health 2014; 8: 218-227 DOI: 10.1002/pmh.1265.
• 36 Niedtfeld I, Schmitt R, Winter D. et al Pain-mediated affect regulation is reduced after dialectical behavior therapy in borderline personality disorder: a longitudinal fMRI study. Soc Cogn Affect Neurosci 2017; 12: 739-747 DOI: 10.1093/scan/nsw183.
• 37 Niedtfeld I, Schulze L, Kirsch P. et al Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Biol Psychiatry 2010; 68: 383-391 DOI: 10.1016/j.biopsych.2010.04.015.
• 38 Schmahl C, Bremner JD. Neuroimaging in borderline personality disorder. J Psychiatr Res 2006; 40: 419-427 DOI: 10.1016/j.jpsychires.2005.08.011.
• 39 Bungert M, Koppe G, Niedtfeld I. et al Pain Processing after Social Exclusion and Its Relation to Rejection Sensitivity in Borderline Personality Disorder. PLoS One 2015; 10: e0133693 DOI: 10.1371/journal.pone.0133693.
• 40 Kluetsch RC, Schmahl C, Niedtfeld I. et al Alterations in default mode network connectivity during pain processing in borderline personality disorder. Arch Gen Psychiatry 2012; 69: 993-1002 DOI: 10.1001/archgenpsychiatry.2012.476.
• 41 Niedtfeld I, Kirsch P, Schulze L. et al Functional connectivity of pain-mediated affect regulation in Borderline Personality Disorder. PLoS One 2012; 7: e33293 DOI: 10.1371/journal.pone.0033293.
• 42 Schmahl C, Baumgartner U. Pain in Borderline Personality Disorder. Mod Trends Pharmacopsychiatry 2015; 30: 166-175 DOI: 10.1159/000435940.
• 43 Vaccarino AL, Sills TL, Evans KR. et al Multiple pain complaints in patients with major depressive disorder. Psychosom Med 2009; 71: 159-162 DOI: 10.1097/PSY.0b013e3181906572.
• 44 Ohayon MM, Schatzberg AF. Chronic pain and major depressive disorder in the general population. J Psychiatr Res 2010; 44: 454-461 DOI: 10.1016/j.jpsychires.2009.10.013.
• 45 Bar KJ, Wagner G, Koschke M. et al Increased prefrontal activation during pain perception in major depression. Biol Psychiatry 2007; 62: 1281-1287 DOI: 10.1016/j.biopsych.2007.02.011.
• 46 Strigo IA, Matthews SC, Simmons AN. Decreased frontal regulation during pain anticipation in unmedicated subjects with major depressive disorder. Transl Psychiatry 2013; 3: e239 DOI: 10.1038/tp.2013.15.
• 47 Strigo IA, Simmons AN, Matthews SC. et al Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry 2008; 65: 1275-1284 DOI: 10.1001/archpsyc.65.11.1275.
• 48 Rodriguez-Raecke R, Ihle K, Ritter C. et al Neuronal differences between chronic low back pain and depression regarding long-term habituation to pain. Eur J Pain 2014; 18: 701-711 DOI: 10.1002/j.1532-2149.2013.00407.x.
• 49 Han C, Pae CU. Pain and depression: a neurobiological perspective of their relationship. Psychiatry Investig 2015; 12: 1-8 DOI: 10.4306/pi.2015.12.1.1.
• 50 Klauenberg S, Maier C, Assion HJ. et al Depression and changed pain perception: hints for a central disinhibition mechanism. Pain 2008; 140: 332-343 DOI: 10.1016/j.pain.2008.09.003.
• 51 Zhao J, Gao X, Wang A. et al Depression comorbid with hyperalgesia: Different roles of neuroinflammation induced by chronic stress and hypercortisolism. J Affect Disord 2019; 256: 117-124 DOI: 10.1016/j.jad.2019.05.065.
• 52 Norman GJ, Karelina K, Zhang N. et al Stress and IL-1beta contribute to the development of depressive-like behavior following peripheral nerve injury. Mol Psychiatry 2010; 15: 404-414 DOI: 10.1038/mp.2009.91.
• 53 Hamilton JP, Etkin A, Furman DJ. et al Functional neuroimaging of major depressive disorder: a meta-analysis and new integration of base line activation and neural response data. Am J Psychiatry 2012; 169: 693-703 DOI: 10.1176/appi.ajp.2012.11071105.
• 54 Manoliu A, Meng C, Brandl F. et al Insular dysfunction within the salience network is associated with severity of symptoms and aberrant inter-network connectivity in major depressive disorder. Front Hum Neurosci 2013; 7: 930 DOI: 10.3389/fnhum.2013.00930.