Providentia

Does Borderline Personality Disorder Affect Pain Sensitivity?

A research study published in the January 2008 issue of the World Journal of Biological Psychiatry compared pain sensitivity in patients with different psychiatric diagnoses under baseline and stress conditions. The study used a sample of 76 female subjects: 16 patients with borderline personality disorder (BPD), 16 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa and 24 healthy controls. Using a contact thermal probe, heat and cold pain thresholds were determined under baseline and stress conditions while mental stress was induced with a cognitive task (Paced Auditory Serial Addition Task). The results showed that pain thresholds in patients with BPD were significantly higher compared to healthy controls under baseline conditions. Patients with PTSD and bulimia nervosa did not show significant differences in pain thresholds compared to healthy controls. Under stress conditions, the difference between BPD patients and healthy controls became even more prominent, whereas the results in the other patient groups remained insignificant. The authors conclude that reduced pain sensitivity is a prominent feature of BPD, which may differentiate this disorder from other stress-related psychiatric conditions.

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Measuring Pain

An article published in the May 2008 issue of The Lancet features the results of a nationwide survey examining chronic pain in a representative sample of individuals across the USA. Using random-digit dialling, a stratified sample of 10,700 individuals were contacted and recruited for the study involving the collection of pain diary information for one 24-h period. Subjects were asked to rate pain on a 0-6 anchored scale for three randomly selected 15-min intervals. Activities of those individuals who reported substantial pain were also examined. Of the 3982 individuals who were interviewed (response rate 37%), 28.8% of men and 26.6% of women reported feeling some pain at the sampled times. Subjects with lower income or less education were found to spend a higher proportion of time in pain and reported higher average pain than did those with higher income or more education.  The average pain rating increased with age, although a plateau was found between the ages of about 45 years and 75 years, with little difference between men and women. Life and health satisfaction varied inversely with reported pain. The authors report that the telephone diary technique represents a promising method for assessing the prevalence of chronic pain and the factors that can interfere with successful coping.

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Chronic Pain in Elderly Patients

In the November 2007 issue of the International Journal of Geriatric Psychiatry, an article presents the result of a study examining chronic pain in depressed geriatric inpatients.  By examining the medical charts of patients who were admitted to a geriatric psychiatric unit over a two year period, 148 patients with a depressive disorder were identified. Of these depressed patients, 62% of patients were found to reports problems with chronic pain. Further analysis found that depressed older adults with chronic pain were more likely to report suicidal ideation, be diagnosed with personality disorder, have chronic care needs, and experience less total sleep time compared to depressed older adults without chronic pain. The results match those of previous studies identifying chronic pain as a possible suicide risk factor in the elderly, particularly when depression is involved.  : Chronic pain-common in depressed older adults-may influence clinical features of depression and should be assessed as a possible suicide risk factor. Prospective studies should examine causal relationships and determine the effects of adequate pain treatment on depression course and suicide risk in older adults.

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Chronic Pain Affects Short-term Memory and Attention

In the May 2007 issue of Anesthesia and Analgesia, a study examining the relationship between chronic pain and performance on neuropsychological measures of short-term memory and attention is presented.  A team of researchers at the University of Alberta administered a series of computerized measures of working (short-term) memory and attention to a sample of chronic pain patients.  Their results indicated that two-thirds of the chronic pain patients tested were found to be impaired on tests of working memory and attention.  Additional factors such as age, education level, disturbed sleep, and pain relief were ruled out as possible confounding factors.  Performance on the cognitive tests was not improved by short-term pain relief using analgesics.   The researchers conclude that chronic pain can directly affect cognitive performance which can, in turn, affect quality of life and level of functioning.    

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