Emotional modulation of pain is preserved in individuals with chronic musculoskeletal pain

French, Julie A.; French, Douglas J.; Poulin, Valérie; France, Christopher; Evans, Robert; Rhudy, Jamie L.; Richard, Dumais

doi:10.1037/e546872013-225

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“…Importantly, the pathophysiological mechanism might not be common to all pain disorders, because emotional modulation of pain was not disrupted in patients with chronic lower back pain (NFR modulation was not tested)[34]. Future studies should examine whether disorders comorbid with FM, insomnia, and MDD (eg, vulvodynia, irritable bowel syndrome) show similar disruptions in emotional modulation of pain to help determine whether a lack of linear valence modulation of pain is a shared phenotype for pain risk.…”

Section: 0 Discussionmentioning

confidence: 99%

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

Terry

DelVentura

Bartley

et al. 2013

Pain

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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.

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confidence: 99%