Der Nervenarzt

, Volume 83, Issue 11, pp 1385–1390

Schmerzverarbeitung bei psychiatrischen Erkrankungen

Leitthema

Zusammenfassung

Viele psychiatrische Erkrankungen gehen mit einer veränderten Schmerzwahrnehmung einher. In einer groben Einteilung könnte man Erkrankungen mit reduzierter Schmerzwahrnehmung (z. B. Borderline-Persönlichkeitsstörung) von Erkrankungen mit verstärkter Schmerzwahrnehmung (z. B. Alkohol- oder Drogenentzug) unterscheiden. Die enge Beziehung zwischen psychiatrischen Erkrankungen und Schmerz ist am ehesten auf Hirnstrukturen zurückzuführen, die bei psychiatrischen Erkrankungen in ihrer Funktion und Struktur verändert sind und wesentlich zur Schmerzverarbeitung beitragen. Am Beispiel der Anorexie soll dies exemplifiziert werden. Viele Studien haben eine Dysfunktion der Insel mit Symptomen der Erkrankung in Zusammenhang gebracht. In diesem Artikel wird dargestellt, dass eine Minderaktivierung der hinteren Insel sowohl die reduzierte Schmerzwahrnehmung aufgrund einer verstärkten adrenergen, deszendierenden Hemmung als auch einen erhöhten Sympathikotonus erklären könnte. So kann beschrieben werden, dass Schmerzforschung bei psychiatrischen Erkrankungen nicht nur schmerzrelevante Ergebnisse liefert, sondern auch die Pathophysiologie der Erkrankung besser verstehen hilft.

Schlüsselwörter

Anorexia nervosa Schmerzforschung Plötzlicher Herztod Autonomes Nervensystem Insel 

The processing of pain in psychiatric diseases

Summary

The perception and processing of pain is disturbed in many psychiatric diseases. Some diseases are known to show decreased perception of pain (e.g. borderline personality disorder), while others are associated with augmented pain perception (e.g. alcohol and drug dependence). The close relationship between psychiatric diseases and pain is most probably caused by aberrant processing of pain in brain structures, known to be involved in psychiatric disorders as well. Aberrant perception and processing of pain in patients with anorexia nervosa (AN) will be used to demonstrate this close relationship. Dysfunction within the insula has been suggested to account for many features of AN and might contribute to reduced pain perception. Moreover, it might lead to increased adrenergic descending inhibition associated with increased sympathetic modulation. Thus, pain research might be able to alter our view on autonomic regulation, which is putatively associated with increased cardiac mortality of the disease.

Keywords

Anorexia nervosa Pain perception Autonomic modulation Cardiac death Insula 

Literatur

  1. 1.
    Bär KJ, Berger S, Schwier C et al (2012) Insular dysfunction and descending pain inhibition in anorexia nervosa. Acta Psychiatr Scand (in press). DOI 10.1111/j.1600-0447.2012.01896.xGoogle Scholar
  2. 2.
    Bär KJ, Boettger S, Wagner G et al (2006) Changes of pain perception, autonomic function, and endocrine parameters during treatment of anorectic adolescents. J Am Acad Child Adolesc Psychiatry 45:1068–1076PubMedCrossRefGoogle Scholar
  3. 3.
    Bär KJ, Greiner W, Letsch A et al (2003) Influence of gender and hemispheric lateralization on heat pain perception in major depression. J Psychiatr Res 37:345–353PubMedCrossRefGoogle Scholar
  4. 4.
    Bär KJ, Terhaar J, Boettger MK et al (2011) Pseudohypoalgesia on the skin: a novel view on the paradox of pain perception in depression. J Clin Psychopharmacol 31:103–107PubMedCrossRefGoogle Scholar
  5. 5.
    Bär KJ, Wagner G, Koschke M et al (2007) Increased prefrontal activation during pain perception in major depression. Biol Psychiatry 62:1281–1287PubMedCrossRefGoogle Scholar
  6. 6.
    Bartak V, Vybiral S, Papezova H et al (2004) Basal and exercise-induced sympathetic nervous activity and lipolysis in adipose tissue of patients with anorexia nervosa. Eur J Clin Invest 34:371–377PubMedCrossRefGoogle Scholar
  7. 7.
    Bickerstaff LK, Harris SC, Leggett RS, Cheah KC (1988) Pain insensitivity in schizophrenic patients. A surgical dilemma. Arch Surg 123:49–51PubMedCrossRefGoogle Scholar
  8. 8.
    Casper RC (2006) The ‚drive for activity‘ and „restlessness“ in anorexia nervosa: potential pathways. J Affect Disord 92:99–107PubMedCrossRefGoogle Scholar
  9. 9.
    Coughlin JW, Edwards R, Buenaver L et al (2008) Pain, catastrophizing, and depressive symptomatology in eating disorders. Clin J Pain 24:406–414PubMedCrossRefGoogle Scholar
  10. 10.
    Zwaan M de, Biener D, Bach M et al (1996) Pain sensitivity, alexithymia, and depression in patients with eating disorders: are they related? J Psychosom Res 41:65–70PubMedCrossRefGoogle Scholar
  11. 11.
    Flor H (2012) New developments in the understanding and management of persistent pain. Curr Opin Psychiatry 25:109–113PubMedCrossRefGoogle Scholar
  12. 12.
    Grunwald M, Ettrich C, Krause W et al (2001) Haptic perception in anorexia nervosa before and after weight gain. J Clin Exp Neuropsychol 23:520–529PubMedCrossRefGoogle Scholar
  13. 13.
    Heinricher MM, Tavares I, Leith JL, Lumb BM (2009) Descending control of nociception: specificity, recruitment and plasticity. Brain Res Rev 60:214–225PubMedCrossRefGoogle Scholar
  14. 14.
    Ishizawa T, Yoshiuchi K, Takimoto Y et al (2008) Heart rate and blood pressure variability and baroreflex sensitivity in patients with anorexia nervosa. Psychosom Med 70:695–700PubMedCrossRefGoogle Scholar
  15. 15.
    Jochum T, Boettger MK, Burkhardt C et al (2010) Increased pain sensitivity in alcohol withdrawal syndrome. Eur J Pain 14:713–718PubMedCrossRefGoogle Scholar
  16. 16.
    Jochum T, Letzsch A, Greiner W et al (2006) Influence of antipsychotic medication on pain perception in schizophrenia. Psychiatry Res 142:151–156PubMedCrossRefGoogle Scholar
  17. 17.
    Kojima S, Nagai N, Nakabeppu Y et al (2005) Comparison of regional cerebral blood flow in patients with anorexia nervosa before and after weight gain. Psychiatry Res 140:251–258PubMedCrossRefGoogle Scholar
  18. 18.
    Koschke M, Boettger MK, Macholdt C et al (2011) Increased QT variability in patients with anorexia nervosa—an indicator for increased cardiac mortality? Int J Eat Disord 43:743–750CrossRefGoogle Scholar
  19. 19.
    Kumar KK, Tung S, Iqbal J (2010) Bone loss in anorexia nervosa: leptin, serotonin, and the sympathetic nervous system. Ann N Y Acad Sci 1211:51–65PubMedCrossRefGoogle Scholar
  20. 20.
    Lautenbacher S, Pauls AM, Strian F et al (1990) Pain perception in patients with eating disorders. Psychosom Med 52:673–682PubMedGoogle Scholar
  21. 21.
    Lautenbacher S, Pauls AM, Strian F et al (1991) Pain sensitivity in anorexia nervosa and bulimia nervosa. Biol Psychiatry 29:1073–1078PubMedCrossRefGoogle Scholar
  22. 22.
    Nunn K, Frampton I, Fuglset TS et al (2011) Anorexia nervosa and the insula. Med Hypotheses 76:353–357PubMedCrossRefGoogle Scholar
  23. 23.
    Nunn K, Frampton I, Gordon I, Lask B (2008) The fault is not in her parents but in her insula – a neurobiological hypothesis of anorexia nervosa. Eur Eat Disord Rev 16:355–360PubMedCrossRefGoogle Scholar
  24. 24.
    Pauls AM, Lautenbacher S, Strian F et al (1991) Assessment of somatosensory indicators of polyneuropathy in patients with eating disorders. Eur Arch Psychiatry Clin Neurosci 241:8–12PubMedCrossRefGoogle Scholar
  25. 25.
    Schmahl C, Bohus M, Esposito F et al (2006) Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry 63:659–667PubMedCrossRefGoogle Scholar
  26. 26.
    Starr CJ, Sawaki L, Wittenberg GF et al (2009) Roles of the insular cortex in the modulation of pain: insights from brain lesions. J Neurosci 29:2684–2694PubMedCrossRefGoogle Scholar
  27. 27.
    Uher R, Brammer MJ, Murphy T et al (2003) Recovery and chronicity in anorexia nervosa: brain activity associated with differential outcomes. Biol Psychiatry 54:934–942PubMedCrossRefGoogle Scholar
  28. 28.
    Wockel L, Hummel T, Zepf FD et al (2007) Changed taste perception in patients with eating disorders. Z Kinder Jugendpsychiatr Psychother 35:423–434PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Klinik für Psychiatrie und Psychotherapie, AG Pain & Autonomic Integrative Research (PAIR)Universitätsklinikum JenaJenaDeutschland

Personalised recommendations