Emotional modulation of pain and spinal nociception in persons with major depressive disorder (MDD)

Abstract

Major depressive disorder (MDD) is associated with risk for chronic pain, but the mechanisms contributing to the MDD and pain relationship are unclear. To examine whether disrupted emotional modulation of pain might contribute, this study assessed emotional processing and emotional modulation of pain in healthy controls and unmedicated persons with MDD (14 MDD, 14 controls). Emotionally-charged pictures (erotica, neutral, mutilation) were presented in four blocks. Two blocks assessed physiological-emotional reactions (pleasure/arousal ratings, corrugator EMG, startle modulation, skin conductance) in the absence of pain and two blocks assessed emotional modulation of pain and the nociceptive flexion reflex (NFR, a physiological measure of spinal nociception) evoked by suprathreshold electric stimulations. Results indicated pictures generally evoked the intended emotional responses; erotic pictures elicited pleasure, subjective arousal, and smaller startle magnitudes, whereas mutilation pictures elicited displeasure, corrugator EMG activation, and subjective/physiological arousal. However, emotional processing was partially disrupted in MDD as evidenced by a blunted pleasure response to erotica and a failure to modulate startle according to a valence linear trend. Furthermore, emotional modulation of pain was observed in controls, but not MDD, even though there were no group differences in NFR threshold or emotional modulation of NFR. Together, these results suggest supraspinal processes associated with emotion processing and emotional modulation of pain may be disrupted in MDD, but brain-to-spinal cord processes that modulate spinal nociception are intact. Thus, emotional modulation of pain deficits may be a phenotypic marker for future pain risk in MDD.

Emotional Modulation of Pain and Spinal Nociception in Persons with Severe Insomnia Symptoms

“…The present data on persons suffering from severe insomnia symptoms parallel those found in recent studies of fibromyalgia and major depressive disorder (17, 33). Specifically, all three groups failed to emotionally modulate pain, but had intact emotional modulation of NFR.…”

“…Given recent evidence that a failure to emotionally modulate pain (but intact NFR modulation) may be associated with chronic pain risk (17, 33, 34), we hypothesized that the insomnia group would exhibit disrupted emotional modulation of pain (i.e., a failure to observe a valence linear trend in pain), but intact NFR modulation. Given that physiological-emotional reactions were assessed in response to emotional pictures (i.e., valence ratings, arousal ratings, facial [corrugator] muscle activity, skin conductance, startle reflex modulation), a secondary goal was to assess group differences in emotional processing.…”

Concomitant depression and anxiety negatively affect pain outcomes in surgically managed young patients with trigeminal neuralgia: Long-term clinical outcome

“…reported that antidepressants in the absence of diagnosed psychiatric disorders in patients with facial pain resulted in 81% being pain free, and minimal surgical intervention for facial pain was a positive predictor of pain relief. [9] In general, patients with any pain and comorbid MDD have a worse prognosis in pain control compared with patients without MDD;[1112161826282931] pain control appears to be more achievable when MDD is also under control in such patients. [151733] Nevertheless patients with psychiatric disorders more often seek care for somatic pain.…”

Latent variable analysis of negative affect and its contributions to neural responses during shock anticipation

“…Pain, an unpleasant sensory and emotional experience associated with actual or potential tissue damage [4], commonly co-occurs with negative affect [5,6]. In fact, research shows increased rates of comorbidity between chronic pain and depression and anxiety [7][8][9][10][11]. Psychological mechanisms that are relevant to the experience of pain and pain disorders are characterized by anxiety sensitivity (e.g., mental, physical, and social concerns) and illness/injury sensitivity (e.g., pain catastrophizing and fear of pain) [12,13].…”