Somatoform Pain Disorder Patients Research Articles

Hyperexcitability of Cortical Oscillations in Patients with Somatoform Pain Disorder: A Resting-State EEG Study

Patients with somatoform pain disorder (SPD) suffer from somatic pain that cannot be fully explained by specific somatic pathology. While the pain experience requires the integration of sensory and contextual processes, the cortical oscillations have been suggested to play a crucial role in pain processing and integration. The present study is aimed at identifying the abnormalities of spontaneous cortical oscillations among patients with SPD, thus for a better understanding of the ongoing brain states in these patients. Spontaneous electroencephalography data during a resting state with eyes open were recorded from SPD patients and healthy controls, and their cortical oscillations as well as functional connectivity were compared using both electrode-level and source-level analysis. Compared with healthy controls, SPD patients exhibited greater resting-state alpha oscillations (8.5-12.5 Hz) at the parietal region, as reflected by both electrode-level spectral power density and exact low-resolution brain electromagnetic tomography (eLORETA) cortical current density. A significant correlation between parietal alpha oscillation and somatization severity was observed in SPD patients, after accounting for the influence of anxiety and depression. Functional connectivity analysis further revealed a greater frontoparietal connectivity of the resting-state alpha oscillations in SPD patients, which was indexed by the coherence between pairs of electrodes and the linear connectivity between pairs of eLORETA cortical sources. The enhanced resting-state alpha oscillation in SPD patients could be relevant with attenuated sensory information gating and excessive integration of pain-related information, while the enhanced frontoparietal connectivity could be reflecting their sustained attention to bodily sensations and hypervigilance to somatic sensations.

Reduced empathic pain processing in patients with somatoform pain disorder: Evidence from behavioral and neurophysiological measures

The present study aimed to investigate the alterations of psychophysiological responses to empathy for pain among patients with somatoform pain disorder (SPD). Behavioral and event-related potential (ERP) responses to pictures depicting hands or feet in different non-painful or painful situations were compared between 18 SPD patients and 18 healthy controls. Patients with SPD reported lower unpleasantness to the observation of others' pain than healthy controls, thus suggesting a reduced affective sharing to others' pain in SPD. While healthy controls showed significant different N2 and P3 responses between painful and non-painful stimulations, no significant difference was observed for patients with SPD. In addition, while both patients and controls showed enlarged late positive potential (LPP) response to painful stimulation than to non-painful stimulation, the differential LPP response was significantly smaller in patients than controls. These ERP results suggested a reduced response to empathy for pain in both early affective and late cognitive temporal stages in SPD. Mediation analysis further revealed that alexithymia mediated the effect of somatoform pain on empathic N2 responses, suggesting that the reduced early affective sharing process in SPD was mediated by their heightened alexithymia. To sum up, our results demonstrated the reduced psychophysiological responses to empathy for pain among patients with SPD, where the reduced affective sharing process could be explained by the concurrent alexithymia. While the altered empathy for pain exhibited by these patients with SPD could impact their social functioning, our study would provide some insights into interventions aimed at improving empathy-related social functioning.

Relationship between theory of mind functions with attachment styles and alexithymia in Somatoform Pain Disorder

There is sparse information available in the literature regarding attachment styles and theory of mind functions with somatoform pain disorder. Thus, the aim of the present study is to investigate the relation between somatoform pain disorder and attachment styles, theory of mind functions and alexithymia. Thirty consecutive somatoform pain disorder patients and age, education level and gender ratio matched 30 controls enrolled for the study. SCID-I Structured Clinical Therapy Patient Form, Adult Attachment Scale (AAS), Toronto Alexithymia Scala (TAS-20) Reading Mind from the Eyes Turkish Form (Eyes Test) procedures were applied to the somatoform pain disorder patients that are investigated. According to results; scores of somatoform pain disorder patients with regards to AAS avoidant subscale score, Difficulty Describing Feelings subscale, Difficulty Identifying Feeling subscale, Externally-Oriented Thinking subscale, total Alexithymia Scale scores have been found significantly higher than that of controls (p

Decreased prefrontal brain activation during verbal fluency task in patients with somatoform pain disorder: An exploratory multi-channel near-infrared spectroscopy study

BackgroundPain is a common phenomenon. Patients with somatoform pain disorder (SPD) suffer from lasting chronic pain which may cause cognitive impairment. The dysfunction of prefrontal cortex (PFC) may be involved in pain-induced cognition impairment, which is the most important part in regulating of cognitive function. Multi-channel near-infrared spectroscopy (NIRS) is a noninvasive and low-cost functional neuroimaging technique being used to detect the prefrontal cortex activation during cognitive tasks to demonstrate the relationship between PFC dysfunction and cognition impairment in SPD patients. Methods24 patients with SPD and 24 age-, gender- and education level-matched healthy controls were examined by NIRS of the relative concentration of oxygenated hemoglobin (oxy-Hb) in PFC during verbal fluency task (VFT). All data analysis procedures were accomplished under MATLAB, SPM and SPM-fNIRS which is an SPM12-based software for fNIRS analysis. Results1. The number of words generated during the VFT tasks in SPD patients were fewer than healthy controls. 2. The activated areas in SPD patients were smaller than healthy controls. 3. The average activation strength of [oxy-Hb] in SPD patients was much lower than healthy controls. 4. The difference of activation areas between left and right lobe were particularly obvious in SPD patients. ConclusionThere are evidences suggested that the markedly dysfunction in PFC especially bilateral dorsolateral prefrontal cortex (DLPFC) areas may be involved in the cognitive deficiency in patients with SPD.

Effectiveness of group cognitive behavioral therapy for somatoform pain disorder patients in Japan: A preliminary non-case-control study.

Somatoform pain disorder is associated with psychosocial dysfunction, and psychotherapies, such as cognitive behavioral therapy (CBT), are thought to provide useful interventions to address such dysfunction as well as the pain itself. However, little is known about whether CBT for somatoform pain disorder is effective, including the long-term course of the illness, in non-Western populations. We therefore tailored such a program based on an existing CBT protocol and examined its effectiveness in Japan. Thirty-four Japanese participants (22 women; mean age = 52.5 years) enrolled in a weekly 12-session group treatment, with 32 completing both wait-list and treatment conditions. The primary outcome measure was pain intensity. Secondary outcome measures included pain characteristics, as measured by pain catastrophizing and psychometric evaluations, including depression, anxiety, and quality of life. The patients were followed up for 12 months after treatment. We found that pain intensity, anxiety, depressive symptoms, and social functioning all significantly improved after treatment compared with the wait-list period, and the improvements in pain intensity, depressive symptoms, and social functioning were sustained at 12 months following the completion of CBT. There were strong positive correlations (P < 0.01) among pre- and post-treatment changes in the affective dimension of pain, depression, anxiety, and pain catastrophizing. These results show that the present CBT program was effective for Japanese patients with somatoform pain disorder and that gains were maintained over the long term. More work is needed to further clarify the effects of CBT interventions on somatoform symptoms, particularly in Japan.

Prevalence of restless legs syndrome in somatoform pain disorder and its effect on quality of life

Background:Persistent somatoform pain disorder (SPD) is a condition in which the patient suffers from persistent, severe and distressing pain; and from associated physical and psychological distress. While presence of restless leg syndrome (RLS) in SPD is understudied, their association might have an impact on general well-being and quality of life (QoL) in SPD.Aims and Objectives:Present study aimed at evaluating the prevalence of RLS in SPD patients attending outpatient department services at a tertiary care institute in eastern India.Materials and Methods:Two hundred and forty consecutive patients with SPD were screened initially and after applying appropriate inclusion and exclusion criteria, 192 subjects (male = 85, female = 107) were included in the study. Severity of RLS was assessed using a questionnaire of the International Restless Legs Syndrome Study Group and QoL was measured on QoL Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF).Results:Revealed a 28% prevalence of RLS is in patients with SPD, which is much higher than its estimated population prevalence. A larger proportion of those with RLS had continuous course of SPD, longer duration of SPD, and higher daytime sleepiness. They also had poorer scores on Q-LES-Q-SF, indicating a poorer QoL overall.Discussion and Conclusion:This is the first report, to the best of our knowledge, on this aspect from India. While this association between RLS and SPD may have biological explanation based on abnormal monoaminergic neurotransmission system, the findings call for more vigilant approach to SPD patients in order to improve their QoL and add to their well-being.

Pain, affect and psychotic illness

Dear colleagues, In order to cope with the increasing amount of interesting papers and due to the fact that Prof. Gattaz (Brazil) and Prof. Deakin (UK) discontinued to be co-editors based on their enormous work load, Hans-Juergen Moller and myself decided to renew and enlarge the editorial board. We are happy that Prof. Takeda (Japan), Prof. Heckers (USA), Prof. McGuire (England), Prof. Leboyer (France), Prof. Arango (Spain), Prof. Maier (Germany) and Prof. Rupprecht (Germany) have accepted our invitation to join the Editorial Board. We will soon decide how we will distribute the scientific fields to the individual members of the Editorial Board in order to improve our review process to maintain and improve the impact of our journal in the field. The current issue of the European Archives focuses on psychotic disorders. De Hert et al. [1] examined the effects of sertindole and risperidone on metabolic parameters in the short- and long-term treatment of schizophrenia. Segarra et al. [2] connect cognitive performance with smoking in first-episode psychosis. They discuss whether smoking in itself is a self-medication approach in order to improve symptoms like dyscognition. Park et al. [3] take up the discussion of olfactory identification, which is in the literature for schizophrenia for sometime but examining the specificity of this funding. Transcranial magnetic stimulation in the treatment of depression has received much attention from clinicians but recently less support in the literature. The paper by Langguth et al. [4] gives a good account of the usefulness of this method in the treatment of depression under naturalistic conditions. Disturbed pain modulation in psychiatric disorders has been underestimated for long time. Especially in somatoform disorders, this is changing recently. The paper by Klug et al. [5] focuses on the issue of dysfunctional pain modulation in somatoform pain disorder patients. Affective disorders are closely connected to the functioning of the immune system. Along these lines, Puustinen et al. [6] examines the association between psychological distress and C-reactive protein levels in the blood. Predicting psychiatric disorders in the offspring is currently discussed intensively. Steinlechner et al. [7] examines this issue from the other side by asking the question whether “Restless legs syndrome” is a possible predictor of psychiatric disorders in parents of children with ADHD. Predicting outcome of severe alcohol-related problems is the basis of a 20-year prospective epidemiological community study by Fichter et al. [8]. These are important data as the majority of our patients will suffer from psychiatric comorbidities for a substantial proportion of their life time. We hope that you will like the mix of papers relating to main topics in our field and enjoy reading this issue of the European Archives.

Erratum to: Dysfunctional pain modulation in somatoform pain disorder patients

Erratum to: Dysfunctional pain modulation in somatoform pain disorder patients

Dysfunctional pain modulation in somatoform pain disorder patients

To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N=15) to age- and sex-matched controls (N=15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.

EEG current source estimation based on variational Bayes – a simulation study

Pain is a common phenomenon. Patients with somatoform pain disorder (SPD) suffer from lasting chronic pain which may cause cognitive impairment. The dysfunction of prefrontal cortex (PFC) may be involved in pain-induced cognition impairment, which is the most important part in regulating of cognitive function. Multi-channel near-infrared spectroscopy (NIRS) is a noninvasive and low-cost functional neuroimaging technique being used to detect the prefrontal cortex activation during cognitive tasks to demonstrate the relationship between PFC dysfunction and cognition impairment in SPD patients.24 patients with SPD and 24 age-, gender- and education level-matched healthy controls were examined by NIRS of the relative concentration of oxygenated hemoglobin (oxy-Hb) in PFC during verbal fluency task (VFT). All data analysis procedures were accomplished under MATLAB, SPM and SPM-fNIRS which is an SPM12-based software for fNIRS analysis.1. The number of words generated during the VFT tasks in SPD patients were fewer than healthy controls. 2. The activated areas in SPD patients were smaller than healthy controls. 3. The average activation strength of [oxy-Hb] in SPD patients was much lower than healthy controls. 4. The difference of activation areas between left and right lobe were particularly obvious in SPD patients.There are evidences suggested that the markedly dysfunction in PFC especially bilateral dorsolateral prefrontal cortex (DLPFC) areas may be involved in the cognitive deficiency in patients with SPD.

Memory performance related to organic and psychosocial illness attributions in somatoform pain disorder patients

Objective Somatoform disorders are characterized by patterns of persistent bodily complaints. Organic illness attributions are assumed to represent a central supporting factor in the development and maintenance of somatoform disorders. Using group control design, we aimed to investigate the processing of illness-belief-related word stimuli in somatoform pain disorder patients. Methods Organic-related, psychosocial-related, and neutral word stimuli were presented to 14 somatoform pain patients with a predominantly organic illness attribution, 14 somatoform pain patients with a predominantly psychosocial illness attribution, and 14 control participants. Behavioral measures were taken during free recall and recognition tasks. Results Our study revealed cognitive impairment in somatoform pain patients with an organic attribution of pain symptoms as compared to somatoform pain patients with a psychosocial attribution and healthy controls in both free recall test and recognition test. However, selective processing of word stimuli was not observed for patient groups. Conclusion We conclude that the observed impairment of memory performance in somatoform pain patients with an organic illness attribution may play an important role in the illness behavior of this patient group and ultimately result in the maintenance of symptoms and a more critical clinical outcome.