Sensation of pain and empathy in patients with pain-predominant multisomatoform disorder – Results of the PISO Imaging Study

Patients with severe and disabling pain which cannot be explained by underlying organic pathology are common in all levels of health care and are typically difficult to treat for physicians as well as for mental health specialists. In this naturalistic fMRI-study using a 3T Scanner and psychometric measures we compared healthy controls with patients suffering from pain-predominant multisomatoform disorder focusing both on task evoked and intrinsic properties of brain function. We could show that the control group exhibits a higher activation of the left perigenual ACC in an empathetic pain paradigm presenting human limbs in painful situations. Moreover, a significantly higher activation was found in the left dorsal ACC by ROI-analysis in the control group. Furthermore, the exposition to the “Pain“-pictures led to relative increases of anterior default mode network activity compared to “No Pain“-stimuli which were also correlated with subjective pain intensity. BOLD-oscillations within a fronto-insular network dedicated to interoception and personal salience showed significantly stronger power densities between 0.2 and 0.24 Hz in patients which might reflect a higher inner arousal and stressed vegetative state. Our results suggest altered computational processes in neural pain processing in chronic pain patients and may lead to an in-depth neurobiological understanding of the well-known clinical impression of underlying emotional deficits in somatoform pain patients.

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Imaging - chronischer Schmerz - somatoforme Störungen