Abstract
Many patients with schizophrenia seem relatively immune to physical pain while others complain of constant pain. This may result from disturbances or alterations of the sensory threshold for pain in populations with psychosis, a possibility for which there is some preliminary evidence. The inconsistency in pain perception may, in part, be explained by the treatments patients receive, but treatment-naïve patients also exhibit differences in response to pain. This suggests that decreased pain sensitivity may represent a specific psychosis endophenotype. Thus far, few experimental studies have investigated sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in psychosis. A digital search for information on this topic was conducted in PubMed and Google Scholar. The result is a non-systematic, narrative review focusing on recent clinical and experimental findings of pain sensitivity in patients with psychosis. Importantly, physical and mental pain are closely connected constructs that may be difficult to differentiate. Our hope is that the review provides some clarity to the field in the specific context of schizophrenia.
Highlights
The inconsistency in pain perception may, in part, be explained by the treatments patients receive, but treatment-naïve patients exhibit differences in response to pain
A routine medical examination was the method used in many studies to explore pain sensitivity in patients with schizophrenia
Since schizophrenia had often been associated with hypoalgesia, a potential way of resolving the contradiction was to conclude that patients with schizophrenia feel pain but do not express it unless asked
Summary
The inconsistency in pain perception may, in part, be explained by the treatments patients receive, but treatment-naïve patients exhibit differences in response to pain. The results of a large number of studies indicate that, as a group, individuals suffering from psychosis show reduced sensitivity to pain when compared to population controls [3,4]. This has been attributed either to increased activity of central endorphins [5] or to the analgesic effects of antipsychotic medication. One small study of 12 participants found that persons with schizophrenia were characterized by elevated sensitivity to acute pain but reduced sensitivity to prolonged pain [12] Another indicated that patients with schizophrenia were
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