Background & Aims

Chronic pain and major depressive disorder (MDD) present together disproportionally often [1,2]. Prior work has found impaired prefrontal-limbic regulation of pain processing in MDD patients which was not correlated to disease severity but to personality traits linked to emotion regulation: neuroti-cism, trait anxiety and pain related catastrophizing (PCS) [3]. Additionally, mood, neuroticism and sleep quality had the highest predictive value for the number of pain sites in acute and chronic pain patients in a recent UK biobank study (N= 493,211) [4]. Increased affective processing may affect the descending pain modulation system – a complex network of neural pathways, brain regions, mid-brain- and brain-stem areas that modulate nociceptive processing at the spinal level [5,6]. Here we aimed to study the dimensional link between the psychological risk architecture and nociceptive pro-cessing alterations in different participants suffering from MDD, primary or secondary chronic pain.

Methods

Here we analyzed a subset of data of a cross-sectional study that included neurophysiological testing (Quantitative Sensory Testing and Conditioned Pain Modulation paradigm) and questionnaires. The total sample (N = 175) consisted of 35 chronic secondary pain patients (CSP, 22 w.), 57 chronic pri-mary pain patients (CPP, 51 w.), 48 MDD patients (31 w.) and 35 healthy controls (21 women). We used Trait anxiety measured by Spielberger’s State Anxiety Inventory [7], Neuroticism measured by the NEO-Five Factor Inventory [8], PCS measured by the Pain Catastrophizing Scale [9] and sleep problems measured by MOS [10] as predictors in multi-level linear regression models computed with the package lme4 in RStudio. We included clinical pain intensity as covariate in the models. The pre-dicted outcome variables were results from neurophysiological testing (CPM effect, PPT) and ques-tionnaires (Widespread-Pain-Index [11], painDetect Score [12], Pain Sensitivity Questionnaire [13] and DN4 [14]).

Results

CPP and MDD patients showed the highest levels of trait anxiety (p <.001) and neuroticism (p <.001), while PCS was highest in the CPP followed by MDD and CSP group (p <.001). In the regression mod-els the PCS total score significantly predicted the pain sensitivity questionnaire result together with the clinical pain intensity (p <.001), while the PCS sub score “helplessness” together with the covari-ate significantly predicted the number of painful regions in the Widespread-Pain-Index (p <.05) and the pressure-pain threshold of the participants (p <.05). The sleep problems index was positively related to the self-report of symptoms linked to spinal sensitization (painDetect questionnaire, p =. 08), irrespective of group. We found an antagonistic moderation effect of clinical pain intensity and trait anxiety in the prediction of CPM efficacy (p <.01). Additionally, Neuroticism showed a synergistic interaction with clinical pain intensity in the prediction of PCS (p <.001).

Conclusions

We conclude from these observations that especially CPP and MDD patients share a clinical psycho-logical risk architecture comprising higher catastrophizing, helplessness, and sleep disturbances, and that the related cortical plasticity facilitates spinal nociceptive processing as proposed earlier [6]. The well-established fear-avoidance-model [15] already stresses that PCS and threat value of medical information are starting points for pain chronification. Our results are in line with recent treatment approaches like the ”Pain Reprocessing Therapy” [16] or “Cognitive Functional Therapy” [17] that share the element of reducing emotional dysregulation and changing fearful beliefs by pain neurosci-ence education and techniques from further therapeutic influences like cognitive behavioral therapy and mindfulness based interventions. A longitudinal design in future studies will help to model time-lagged mediation-models to gain potential causal insights.

References

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[17] O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive functional therapy: an integrated behavioral approach for the targeted man-agement of disabling low back pain. Physical therapy, 98(5), 408-423.

Presenting Author

Hannah Schmidt

Poster Authors

Hannah Schmidt

M. Sc.

Central Institute of Mental Health, Mannheim, Heidelberg University

Lead Author

E-mail

Malika Renz

M.Sc.

Central Institute of Mental Health, Mannheim

Lead Author

E-mail

Armin Drusko

M.Sc.

Department of Internal Medicine and Psychosomatics, University Clinic Heidelberg

Lead Author

E-mail

Carmel Kerem

Neurophysiology Department, Mannheim Medical Faculty, Heidelberg University

Lead Author

E-mail

Heike Tost

Prof. Dr. Dr.

Central Institute of Mental Health, Mannheim

Lead Author

E-mail

Jonas Tesarz

University Hospital Heidelberg

Lead Author

E-mail

Andreas Meyer-Lindenberg

Professor Dr.

Central Institute of Mental Health, Mannheim

Lead Author

E-mail

Rolf-Detlef Treede

Prof. Dr.

Central Institute of Mental Health, Mannheim

Lead Author

E-mail

Topics

  • Mechanisms: Biological-Systems (Physiology/Anatomy)