Skip to main content
SpringerLink
Log in

Schmerzverarbeitung bei Borderline-Persönlichkeitsstörung, Fibromyalgie und Posttraumatischer Belastungsstörung

Pain processing in patients with borderline personality disorder, fibromyalgia, and post-traumatic stress disorder

  • Übersichten
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Diese Übersicht fasst relevante experimentelle Studien zur Schmerzwahrnehmung und Schmerzverarbeitung bei ausgewählten psychiatrischen Störungsbildern zusammen, bei denen traumatischer Stress in der Ätiologie eine Rolle spielt. Bei der Borderline-Persönlichkeitsstörung, der Posttraumatischen Belastungsstörung und der Fibromyalgie bestehen Hinweise auf unterschiedliche neurophysiologische und neuropsychologische Schmerzverarbeitungsmuster. Experimentelle Studien bei Borderline-Patienten zeigen eine Desensibilisierung hinsichtlich der Schmerzschwellen, Fibromyalgiepatienten weisen ein entgegengesetztes Muster auf, welches auf eine zentrale Sensibilisierung hinweist. Es wird weiterhin ein kurzer Überblick über Methoden zur Erhebung der Schmerzwahrnehmung (peripher und zentral) sowie zu neurobiologischen Mechanismen der Schmerzverarbeitung gegeben. Hier wird im Besonderen auf die Unterscheidung zwischen dem sensorisch-diskriminativen System und dem affektiv-motivationalen System Bezug genommen. Bezogen auf den Ergebnisstand der aktuellen Forschung werden ein Ausblick auf zukünftige Forschung und therapeutische Implikationen dargestellt.

Abstract

The authors review relevant experimental studies on pain perception and processing in psychiatric disorders with traumatic stress as an etiological factor. In borderline personality disorder, post-traumatic stress disorder, and fibromyalgia neurophysiological and neuropsychological patterns of pain processing appear to be different. Experimental studies in borderline patients show a desensitization of pain thresholds whereas patients with fibromyalgia show an opposite pattern, which could be explained by a central augmentation of pain processing. Furthermore, the authors outline methods to assess pain perception (peripheral and central) and describe the neurobiological mechanisms of pain processing, particularly the distinction between the sensory-discriminative lateral system and the affective-motivational medial system. Finally, suggestions for further research and implications for therapy are proposed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Asmundson GJ, Coons MJ, Taylor S, Katz J (2002) PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry 47:930–937

    PubMed  Google Scholar 

  2. Azad SC, Zieglgänsberger W (2003) Was wissen wir über die Chronifizierung von Schmerz? Schmerz 17:441–444

    Article  CAS  PubMed  Google Scholar 

  3. Baune BT, Aljeesh Y (2004) Sind Schmerzen ein klinisch relevantes Problem in der Allgemeinpsychiatrie? Eine klinisch-epidemiologische Querschnittsstudie bei Patienten mit psychischen Störungen. Schmerz 18:28–37

    Article  PubMed  Google Scholar 

  4. Birbaumer N, Schmidt R (1999) Biologische Psychologie, 4. Aufl. Springer, Berlin Heidelberg New York

  5. Blanchard EB, Hickling EJ, Taylor AE, Loos WR, Gerardi RJ (1994) The psychophysiology of motor vehicle accident related posttraumatic stress disorder. Behav Ther 25:453–467

    Google Scholar 

  6. Bohus M, Limberger M, Ebner U, Glocker F, Wernz M, Lieb K (2000) Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res 95:251–260

    Article  CAS  PubMed  Google Scholar 

  7. Bornhövd K, Quante M, Glauche V, Bromm B, Weiller C, Büchel C (2002) Painful stimuli evoke different stimulus-response functions in the amygdala, prefrontal, insula and somatosensory cortex: a single-trial fMRI study. Brain 125:1326–1336

    Article  PubMed  Google Scholar 

  8. Bradley LA, McKendree-Smith NL, Alberts KR, Alarcón GS, Mountz JM, Deutsch G (2000) Use of neuroimaging to understand abnormal pain sensitivity in fibromyalgia. Curr Rheumatol Rep 2:41–48

    Google Scholar 

  9. Bremner JD, Staib LH, Kaloupek D, Southwick SM, Soufer R, Charney DS (1999) Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: a positron emission tomography study. Biol Psychiatry 45:806–816

    Article  CAS  PubMed  Google Scholar 

  10. Brodsky BS, Cloitre M, Dulit RA (1995) Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder. Am J Psychiatry 152:1788–1792

    CAS  PubMed  Google Scholar 

  11. Bromm B (1997) Laser evoked brain potentials in the assessment of pain: methods, applications, brain source analyses. Pain Res 12:41–57

    Google Scholar 

  12. Clarkin J, Widiger T, Frances A, Hurt W, Gilmore M (1983) Prototypic typology and the borderline personality disorder. J Abnorm Psychol 92:263–275

    Article  CAS  PubMed  Google Scholar 

  13. Coderre TJ, Katz J, Vaccarino AL, Melzack R (1993) Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 52:259–285

    CAS  PubMed  Google Scholar 

  14. Coghill RC, McHaffie JG, Yen Y-F (2003) Neural correlates of interindividual differences in the subjective experience of pain. PNAS 100:8538–8542

    Article  CAS  PubMed  Google Scholar 

  15. Cohen H, Neumann L, Haiman Y, Matar MA, Press J, Buskila D (2002) Prevalence of post-traumatic stress disorder in fibromyalgia patients: overlapping syndromes or post-traumatic fibromyalgia syndrome? Semin Arthritis Rheum 32:38–50

    Article  PubMed  Google Scholar 

  16. Coid JW (1983) An affective syndrome in psychopaths with borderline personality disorder? Br J Psychiatry 162:641–650

    Google Scholar 

  17. Craig AD, Dostrovsky JO (1998) Processing of nociceptive information at supraspinal levels. In: Yaksh TL (ed) Anesthesia: biologic foundations. Lippincott-Raven, Philadelphia, PA, pp 625–642

  18. Davis GC, Buchsbaum MS, Bunney WE (1979) Analgesia to painful stimuli in affective illness. Am J Psychiatry 136:1148–1151

    CAS  PubMed  Google Scholar 

  19. Davis GC, Buchsbaum MS, Naber D, Pickar D, Post R, van Kammen D, Bunney WE (1982) Altered pain perception and cerebrospinal endorphins in psychiatric illness. NYAS 398:366–373

    CAS  Google Scholar 

  20. De La Fuente JM (1997) Brain glucose metabolism in borderline personality disorder. J Psychiatr Res 31:531–541

    Article  PubMed  Google Scholar 

  21. Delaplaine R, Ifabumuyi OI, Merskey H, Zarfas J (1978) Significance of pain in psychiatric hospital patients. Pain 4:361–366

    Article  CAS  PubMed  Google Scholar 

  22. Derbyshire SW, Jones AK, Devani P, Friston KJ, Feinmann C, Harris M, Pearce S, Watson JD, Frackowiak RS (1994) Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography. J Neurol Neurosurg Psychiatry 57:1166–1172

    CAS  PubMed  Google Scholar 

  23. Desmeules JA, Cedraschi C, Rapiti E, Baumgartner E, Finckh A, Cohen P, Dayer P, Vischer TL (2003) Neurophysiological evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum 48:1420–1429

    Article  CAS  PubMed  Google Scholar 

  24. Egle UT, Hoffmann SO, Steffens M (1997) Psychosoziale Risiko- und Schutzfaktoren in Kindheit und Jugend als Prädisposition für psychische Störungen im Erwachsenenalter. Nervenarzt 68:683–695

    Article  CAS  PubMed  Google Scholar 

  25. Favazza A (1989) Suicide gestures and self-mutilation. Am J Psychiatry 146:408–409

    CAS  Google Scholar 

  26. Flor H (2002) Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol 1:182–189

    Article  PubMed  Google Scholar 

  27. Friederich HC, Schellberg D, Mueller K, Bieber C, Zipfel S, Eich W (2005) Stress und autonome Dysregulation bei Patienten mit einem Fibromyalgiesyndrom. Schmerz 19:185–194

    Article  PubMed  Google Scholar 

  28. Gaab J, Cleare AJ (2003) Fibromyalgie und chronisches Erschöpfungssyndrom. In: Ehlert U (Hrsg) Verhaltensmedizin. Springer, Berlin Heidelberg New York, S 471–495

  29. Gladstone GL, Parker GB, Mitchell PB, Malhi GS, Wilhelm K, Austin M-P (2004) Implications of childhood trauma for depressed women: an analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization. Am J Psychiatry 161:1417–1425

    Article  PubMed  Google Scholar 

  30. Goldberg RT, Pachas WN, Keith D (1999) Relationship between traumatic events in childhood and chronic pain. J Disability Rehab 21:23–30

    Article  CAS  Google Scholar 

  31. Gracely RH, Petzke F, Wolf JM, Clauw DJ (2002) Functional magnet resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 46:1333–1343

    Article  PubMed  Google Scholar 

  32. Gracely RH, Geisser ME, Giesecke T, Grant MAB, Petzke F, Williams DA, Clauw DJ (2004) Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain Adv Access 127:835–843

    CAS  Google Scholar 

  33. Greenstein B, Greenstein A (2000) Color atlas of neuroscience. Neuroanatomy and neurophysiology. Thieme, Stuttgart New York

  34. Guilbaud G, Bernard JF, Besson JM (1994) Brain areas involved in nociception and pain. In: Wall PD, Melzack R (eds) Textbook of pain. Churchill Livingstone, Edinburgh, pp 113–128

  35. Hall KRL, Stride E (1995) The varying response to pain in psychiatric disorders: a study in abnormal psychology. Br J Med Psychol 27:48–60

    Google Scholar 

  36. Herpertz S (1995) Self-injurious behavior: psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand 9:57–68

    Google Scholar 

  37. Hurtig IM, Raak RI, Kendall SA, Gerdle B, Wahren LK (2001) Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups. Clin J Pain 17:316–322

    Article  CAS  PubMed  Google Scholar 

  38. Ingvar DH, Rosen I, Elmquist D (1976) Activation patterns induced in the dominant hemisphere by skin stimulation. In: Zimmermann Y (ed) Sensory functions of the skin. Pergamon Press, Oxford

  39. Jones AK, Derbyshire SW (1997) Reduced cortical responses to noxious heat in patients with rheumatoid arthritis. Ann Rheum Dis 56:601–607

    CAS  PubMed  Google Scholar 

  40. Juengling FD, Schmahl CG, Hesslinger B, Ebert D, Bremner JD, Gostomzyk J, Bohus M, Lieb K (2003) Positron emission tomography in female patients with borderline personality disorder. J Psychiatr Res 37:109–115

    Article  CAS  PubMed  Google Scholar 

  41. Knorring L (1974) An intraindividual comparison of pain measures, averaged evoked responses and clinical ratings during depression and recovery. Acta Psychiatr Scand 255 [suppl]:121–133

    Google Scholar 

  42. Kosek E, Ekholm J, Hansson P (1996) Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 68:375–389

    Article  CAS  PubMed  Google Scholar 

  43. Lautenbacher S, Krieg J-C (1994) Pain perception in psychiatric disorders: a review of the literature. J Psychiatr Res 28:109–121

    Article  CAS  PubMed  Google Scholar 

  44. Lautenbacher S, Rollman GB (1997) Possible deficiencies of pain modulatoin in fibromyalgia. Clin J Pain 13:189–196

    Article  CAS  PubMed  Google Scholar 

  45. Liberzon I, Taylor SF, Amdur R, Jung TD, Chamberlain KR, Minoshima S, Koeppe RA, Fig LM (1999) Brain activation in PTSD in response to trauma related stimuli. Soc Biol Psychiatry 45:817–826

    Article  CAS  Google Scholar 

  46. Lorenz J, Grasedyck K, Bromm B (1996) Middle and long latency somatosensory evoked potentials after painful laser stimulation in patients with fibromyalgia syndrome. Electroencephalogr Clin Neurophysiol 100:165–168

    Article  CAS  PubMed  Google Scholar 

  47. Lorenz J, Minoshima S, Casey KL (2003) Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation. Brain 126:1079–1091

    Article  CAS  PubMed  Google Scholar 

  48. McDermind AJ, Rollmann GB, McCain GA (1996) Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 66:133–144

    Article  PubMed  Google Scholar 

  49. Melzack R, Casey KL (1968) Sensory, motivational, and central control determinants of pain. A new conceptional model. In: Kenshalo DR (ed) The skin senses. Thomas, Springfield, MA, pp 423–443

  50. Orr SP, Pitman RK, Lasko NB, Herz LR (1993) Psychophysiologic assessment of posttraumatic stress disorder imagery in world war II and Korean combat veterans. J Abnorm Psychol 102:152–159

    Article  CAS  PubMed  Google Scholar 

  51. Orr SP, Lasko NB, Metzger LJ, Berry NJ, Ahern CE, Pitman RK (1998) Psychophysiologic assessment of women with PTSD resulting from childhood sexual abuse. J Consult Clin Psychol 66:906–913

    Article  CAS  PubMed  Google Scholar 

  52. Orr SP, Lasko NB, Metzger LJ, Macklin ML, Peri T, Pitman RK (2000) De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder. J Abnorm Psychol 109:290–298

    Article  CAS  PubMed  Google Scholar 

  53. Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59

    Article  CAS  PubMed  Google Scholar 

  54. Petzke F, Clauw DJ, Ambrose K, Khine A, Gracely RH (2003) Increased pain sensitivity in fibromyalgia: effects of stimulus type and mode of presentation. Pain 105:403–413

    Article  PubMed  Google Scholar 

  55. Pitman RK, Orr SP, Forgue DF, de Jong JB, Claiborn, JM (1987) Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry 150:620–624

    Google Scholar 

  56. Pitman RK, van der Kolk BA, Orr SP, Greenberg MS (1990) Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder. A pilot study. Arch Gen Psychiatry 47:541–545

    CAS  PubMed  Google Scholar 

  57. Ploner M, Schnitzler A (2004) Kortikale Repräsentation von Schmerz. Nervenarzt, Epub ahead of print

  58. Rainville P, Duncan GH, Price DD et al. (1997) Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 277:968–971

    Article  CAS  PubMed  Google Scholar 

  59. Rauch SL, van der Kolk BA, Fisler RE, Alpert NM, Orr SP, Savage CR, Fischman AJ, Jenike MA, Pitman RK (1996) A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Arch Gen Psychiatry 154:918–925

    Google Scholar 

  60. Rolke R, Magerl W, Andrews Campbell K, Schalber C, Caspari S, Birklein F, Treede RD (2005) Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain (in press)

    Google Scholar 

  61. Russ MJ, Roth SD, Lerman A, Kakuma T, Harrison K, Shindledecker RD, Hull J, Mattis S (1992) Pain perception in self-injurious patients with borderline personality disorder. Biol Psychiatry 32:501–511

    Article  CAS  PubMed  Google Scholar 

  62. Russ MJ, Roth, SD, Kakuma T, Harrison K, Hull JW (1994) Pain perception in self-injurious borderline patients: naloxone effects. Soc Biol Psychiatry 35:207–209

    Article  CAS  Google Scholar 

  63. Schmahl CG, McGlashan TH, Bremner JD (2002) Neurobiological correlates of borderline personality disorder. Gen Psychopharmacol 36:69–85

    Google Scholar 

  64. Schmahl C, Greffrath W, Baumgärtner U, Schlereth T, Magerl W, Philipsen A, Lieb K, Bohus M, Treede R-D (2004) Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behaviour: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain 110:470–479

    Article  PubMed  Google Scholar 

  65. Schmahl C, Bohus M, Esposito F, Treede RD, Di Salle F, Greffrath W, Ludaescher P, Lieb K, Scheffler K, Hennig J, Seifritz E (2005) Neural correlates of antinociception in borderline personality disorder. Eingereicht zur Veröff.

  66. Shalev AY, Orr SP, Pitman RK (1993) Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder. Am J Psychiatry 150:620–624

    CAS  PubMed  Google Scholar 

  67. Shalev AY, Peri T, Canetti L, Schreiber S (1996) Predictors of post-traumatic stress-disorder in injured trauma survivors: a prospective study. Am J Psychiatry 153:219–225

    CAS  PubMed  Google Scholar 

  68. Sharp TJ, Harvey AG (2001) Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 21:857–877

    Article  CAS  PubMed  Google Scholar 

  69. Shin LM, Kosslyn SM, McNally RJ (1997) Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation. Arch Gen Psychiatry 54:233–241

    CAS  PubMed  Google Scholar 

  70. Smith MY, Egert J, Winkel G, Jacobson J (2002) The impact of PTSD on pain experience in persons with HIV/AIDS. Pain 98:9–17

    Article  PubMed  Google Scholar 

  71. Staud R, Smitherman ML (2002) Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep 6:259–266

    PubMed  Google Scholar 

  72. Stiglmayr C, Shapiro D, Stiglitz R, Limberger M, Bohus M (2001) Experience of eversive tension and dissociation in female patients with borderline personality disorder — a controlled study. J Psychiatry Res 35:111–118

    Article  CAS  Google Scholar 

  73. Torgersen S, Kringlen E, Cramer V (2001) The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 58:590–596

    Article  CAS  PubMed  Google Scholar 

  74. Treede RD (2001) Neural basis of pain. In: Smelser NJ, Baltes PB (eds) Encyclopedia of the social and behavioral sciences, vol 16. Elsevier, Amsterdam, pp 11000–11005

  75. Treede R-D, Kenshalo DR, Gracely RH, Jones AKP (1999) The cortical representation of pain. Pain 79:105–111

    Article  CAS  PubMed  Google Scholar 

  76. Vaitl D, Schienle A, Stark R (2003) Emotionen in der Psychotherapie. In: Schiepek G (Hrsg) Neurobiologie der Psychotherapie. Schattauer, Stuttgart

  77. Van Houdenhove B, Egle U (2004) Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom 73:267–275

    Article  PubMed  Google Scholar 

  78. Wik G, Fischer H, Bragée B, Kristianson M, Fredrikson M (2003) Retrosplenial cortical activation in the fibromyalgia syndrome. NeuroReport 14:619–621

    Article  PubMed  Google Scholar 

  79. Wolfe F et al. (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis Rheum 33:160–72

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit Mannheim

    A. Jochims, P. Ludäscher, M. Bohus &  C. Schmahl

  2. Institut für Physiologie und Pathophysiologie, Johannes-Gutenberg-Universität Mainz

    R.-D. Treede

  3. Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, J5, 68159 , Mannheim

    C. Schmahl

Authors
  1. A. Jochims
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Ludäscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Bohus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R.-D. Treede
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Schmahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Schmahl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jochims, A., Ludäscher, P., Bohus, M. et al. Schmerzverarbeitung bei Borderline-Persönlichkeitsstörung, Fibromyalgie und Posttraumatischer Belastungsstörung. Schmerz 20, 140–150 (2006). https://doi.org/10.1007/s00482-005-0405-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-005-0405-z

Schlüsselwörter

Keywords

Search

Navigation