Dissecting pain processing in adolescents with Non-Suicidal Self Injury: Could suicide risk lurk among the electrodes?

Caterina Leone,Mattia Fortunato,Serena Galosi,Sofia Misuraca,Chiara Possidente,Arianna Terrinoni,Luana Berillo,Valeria Milone,Andrea Truini,Cristina Mollica,Mauro Ferrara,Giorgio Cruccu

doi:10.1002/ejp.1793

Caterina Leone, Mattia Fortunato + Show 10 more

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https://doi.org/10.1002/ejp.1793

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Abstract

BackgroundAlthough non‐suicidal self‐injury (NSSI) disorder is highly prevalent in adolescents, its relationship with pain system function and suicidality is still controversial. The present study was designed to assess the function of the nociceptive afferent pathways and the endogenous pain modulation in adolescent patients with NSSI and to longitudinally register any suicide attempt, describe its frequency and find a possible association between suicide, neurophysiological measures and psychological measures.MethodsWe enrolled 30 adolescents suffering from NSSI and 20 age‐ and gender‐matched healthy controls. Patients underwent a comprehensive psychological evaluation. Each participant underwent thermal pain thresholds of the quantitative sensory testing, laser‐evoked potential recording to study the ascending nociceptive pathway and the conditioned pain modulation testing to test the endogenous pain modulation.ResultsWe found that patients with NSSI had a reduced amplitude of the N2 component of laser‐evoked potentials and an abnormal conditioned pain modulation. The amplitude of the N2 was associated with suicidal risk.ConclusionsThe deficit of the endogenous pain modulation likely depends on a saturation due to continuous pain solicitation. The strong association of a reduced amplitude of the N2 component with suicide suggests that it may serve as a possible biomarker in self‐harming adolescents.SignificanceThe present study identifies the N2 component of laser‐evoked potentials as a possible neurophysiological biomarker of suicidal risk in patients with non‐suicidal self‐injury, therefore, raising the possibility for a non‐invasive test to identify subjects at higher risk of suicide among self‐harming patients.

Highlights

Non-suicidal self-injury (NSSI) is broadly defined as a direct, not socially sanctioned behaviour that causes physical injury which results in the destruction of one's own body tissue in the absence of any observable intent to die (Muehlenkamp, 2005)
Given the lack of results on adolescents with recent diagnosis of non-suicidal self-injury (NSSI) not associated with borderline personality disorder (BPD), it is not clear whether the pain system abnormality is present since disease onset, or rather should be attributed to the severity and duration of the disease, or to the association with a major psychiatric disorder
We found no significant correlation between duration and severity of the disease with thermal and pinprick thresholds, pain ratings and laser-evoked potentials (LEP)/conditioned pain modulation (CPM) variables among the patients’ group

Summary

| INTRODUCTION

Non-suicidal self-injury (NSSI) is broadly defined as a direct, not socially sanctioned behaviour that causes physical injury which results in the destruction of one's own body tissue in the absence of any observable intent to die (Muehlenkamp, 2005). Given the lack of results on adolescents with recent diagnosis of NSSI not associated with BPD, it is not clear whether the pain system abnormality is present since disease onset, or rather should be attributed to the severity and duration of the disease, or to the association with a major psychiatric disorder. We performed a cross-sectional neurophysiological study of a homogeneous population of adolescents with NSSI versus a control population aiming to: (1) assess the integrity of the pain system in terms of thermal pain thresholds, laser pinprick thresholds, laser-e voked potentials and endogenous pain modulation and (2) find a possible correlation between the above-m entioned parameters and the severity and duration of the disease. We longitudinally a) described the prevalence of suicide in our population, b) identified two distinct populations of patients (suicidal and non-suicidal) to compare their neurophysiological and psychological data, collected in the first part of the study and c) assessed the presence of any predictive factor for suicidality among the variables recorded during the study

| MATERIALS AND METHODS

| Statistical methods

| DISCUSSION

Findings

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