Temporal Summation of Pain Unpleasantness Is Increased in Borderline Personality Disorder

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-05-22 DOI:10.1002/ejp.70042

Annette Löffler, Dieter Kleinböhl, Sylvia Steinmann, Sabine C. Herpertz, Ute Habel, Robin Bekrater-Bodmann, Herta Flor

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Abstract

Background

Borderline personality disorder (BPD) is characterised by deficient regulation of emotions and is associated with reduced pain sensitivity, which has been related to self-injury and dissociation. BPD can therefore be used as a model to better understand pain-modulating mechanisms and their association with affective processing. However, studies assessing pain-modulating processes in BPD are sparse.

Methods

This study investigated temporal summation (TS) of pain intensity and unpleasantness, as well as TS of the RIII-reflex as a marker for spinal nociceptive processing in 24 participants with BPD compared to 24 non-clinical controls (NCC).

Results

Our main result showed that TS of pain unpleasantness, but not TS of pain intensity, was significantly increased in BPD compared to NCC, whereas we replicated higher pain thresholds in BPD compared to NCC. There was no significant correlation between pain threshold and TS of pain intensity or TS of pain unpleasantness in BPD. Moreover, correlative findings suggest a mutual dependence of spinal processing, temporal summation of pain and stimulus intensity in NCC, but not in participants with BPD.

Conclusions

The combination of reduced pain sensitivity in terms of heightened pain threshold and enhanced TS of pain unpleasantness might explain the so-called pain paradox, describing that individuals with BPD are both hyposensitive to acute pain and more prone to develop chronic pain. Different mechanisms might underlie heightened pain thresholds and increased TS of pain unpleasantness based on a complex interaction of altered ascending and descending mechanisms.

Significance Statement

The results of this study provide evidence that temporal summation of pain unpleasantness is increased in individuals with borderline personality disorder compared to non-clinical controls. These data suggest that altered pain perception in BPD is composed of several processes, extending beyond well-known pain insensitivity.

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边缘型人格障碍患者疼痛、不愉快的时间总和增加

边缘型人格障碍（BPD）的特征是缺乏情绪调节，并与疼痛敏感性降低有关，这与自残和分离有关。因此，BPD可以作为一个模型来更好地理解疼痛调节机制及其与情感处理的关联。然而，评估BPD中疼痛调节过程的研究很少。方法研究了24例BPD患者与24例非临床对照（NCC）的疼痛强度和不愉快的时间总和（TS），以及作为脊髓伤害性加工标志的iii -反射的TS。结果我们的主要结果显示BPD的疼痛不愉快TS比NCC显著增加，而疼痛强度TS没有显著增加，而BPD的疼痛阈值比NCC高。BPD患者疼痛阈值与疼痛强度TS、疼痛不愉快TS无显著相关性。此外，相关研究结果表明，NCC的脊髓加工、疼痛的时间累积和刺激强度相互依赖，而BPD的参与者则不是。结论BPD患者在疼痛阈值升高方面的疼痛敏感性降低和疼痛不愉快的TS增强的结合可能解释了所谓的疼痛悖论，即BPD患者对急性疼痛不敏感，更容易发展为慢性疼痛。基于复杂的上升和下降机制的相互作用，不同的机制可能会导致疼痛阈值升高和疼痛不愉快的TS增加。本研究的结果提供证据表明，与非临床对照相比，边缘型人格障碍患者的疼痛和不愉快的时间总和增加。这些数据表明BPD患者疼痛感知的改变是由几个过程组成的，超出了众所周知的疼痛不敏感。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.