Abstract
Abnormalities in pain processing have been observed in patients with chronic pain conditions and in individuals who engage in self-harm, specifically nonsuicidal self-injurious behaviors (NSSI). Both increased and decreased pain sensitivity have been described in chronic pain patients, while decreased pain sensitivity is consistently observed in individuals with NSSI. The objective of the study was to identify the differential effects of chronic pain and NSSI on experimental pain sensitivity, specifically pressure pain threshold, in depressed patients. Moreover, the role that hopelessness may play between depression severity and pain sensitivity was also examined. Depressed patients with and without chronic pain, and with and without lifetime self-harm behaviors were analyzed into four groups. Group 1 (N = 42) included depressed patients with both Chronic pain ( +) and Self-harm ( +), Group 2 (N = 53) included depressed patients with Chronic pain ( +) but no Self-harm (−), Group 3 (N = 64) included depressed patients without Chronic pain (−), but Self-harm ( +), and Group 4 (N = 81) included depressed patients with neither Chronic pain (−) nor Self-harm (−). Healthy controls (N = 45) were also recruited from the community. Depressed patients with both Chronic pain ( +) and Self-harm ( +) reported higher pressure pain threshold measures when compared with the other groups. Mediation analysis indicated that hopelessness mediates the relationship between depression severity and pressure pain threshold. Our findings suggest that a multiprong approach including adequate mental health services and pain control for depressed patients with comorbid chronic pain and nonsuicidal self-harm is needed to yield effective outcomes.
Similar content being viewed by others
References
Alali T (2016) The relationship between anxiety, depression and hopelessness among nonclinical sample. Eur Psychiatry 33:S156–S156
Alsalman R, Alansari B (2016) Relationship of suicide ideation with depression and hopelessness. Eur Psychiatry 33:S597–S597
Ammerman BA, Burke TA, Alloy LB, McCloskey MS (2016) Subjective pain during NSSI as an active agent in suicide risk. Psychiatry Res 236:80–85
Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, Graaf RD, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler RC (2003) The epidemiology of major depressive episodes: results from the international consortium of psychiatric epidemiology (icpe) surveys. Int J Methods Psychiatr Res 12:3–21
Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, Kraemer HC, Dea R, Robinson R, Hayward C (2006) Comorbid depression, chronic pain, and disability in primary care. Psychosom Med 68:262–268
Asarnow JR, Porta G, Spirito A, Emslie G, Clarke G, Wagner KD, Vitiello B, Keller M, Birmaher B, McCracken J (2011) Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the tordia study. J Am Acad Child Adolesc Psychiatry 50:772–781
Asmundson GJ, Katz J (2009) Understanding the co-occurrence of anxiety disorders and chronic pain: State-of-the-art. Depress Anxiety 26:888–901
Association AP (2013) Diagnostic and statistical manual of mental disorders (dsm-5®). American Psychiatric Pub
Aweid O, Gallie R, Morrissey D, Crisp T, Maffulli N, Malliaras P, Padhiar N (2014) Medial tibial pain pressure threshold algometry in runners. Knee Surg Sports Traumatol Arthrosc 22:1549–1555
Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163:2433–2445
Bastian B, Jetten J, Fasoli F (2011) Cleansing the soul by hurting the flesh: the guilt-reducing effect of pain. Psychol Sci 22:334
Beck AT (1988) Beck hopelessness scale. Psychological Corporation, San Antonio, TX
Beck AT, Steer RA (1990) Manual for the Beck anxiety inventory. Psychological Corporation, San Antonio, TX
Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess 67:588–597
Bondesson E, Larrosa Pardo F, Stigmar K, Ringqvist Å, Petersson I, Jöud A, Schelin M (2018) Comorbidity between pain and mental illness–evidence of a bidirectional relationship. Eur J Pain 22:1304–1311
Bonenberger M, Plener PL, Groschwitz RC, Grön G, Abler B (2015) Differential neural processing of unpleasant haptic sensations in somatic and affective partitions of the insula in non-suicidal self-injury (NSSI). Psychiatry Res 234:298–304
Boscarino JA, Rukstalis MR, Hoffman SN, Han JJ, Erlich PM, Ross S, Gerhard GS, Stewart WF (2011) Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the dsm-5 vs. Dsm-4 diagnostic criteria. J Addict Dis 30:185–194
Breslau N, Schultz L, Lipton R, Peterson E, Welch K (2012) Migraine headaches and suicide attempt. Headache 52:723–731
Briere J, Gil E (1998) Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 68:609–620
Caceda R, Carbajal JM, Salomon RM, Moore JE, Perlman G, Padala PR, Hasan A, Delgado PL (2020) Slower perception of time in depressed and suicidal patients. Eur Neuropsychopharmacol 40:4–16. https://doi.org/10.1016/j.euroneuro.2020.09.004
Cáceda R, James GA, Stowe ZN, Delgado PL, Kordsmeier N, Kilts CD (2020) The neural correlates of low social integration as a risk factor for suicide. Eur Arch Psychiatry Clin Neurosci 270:619–631
Cáceda R, Kordsmeier NC, Golden E, Gibbs HM, Delgado PL (2017) Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom 86:116–118
Cáceda R, Kordsmeier NC, Golden E, Gibbs HM, Delgado PL (2017) Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom 86:116–118
Campbell G, Bruno R, Darke S, Shand F, Hall W, Farrell M, Degenhardt L (2016) Prevalence and correlates of suicidal thoughts and suicide attempts in people prescribed pharmaceutical opioids for chronic pain. Clin J Pain 32:292–301
Cheatle MD (2011) Depression, chronic pain, and suicide by overdose: on the edge. Pain Med 12:S43–S48
Cohen MJ, Naliboff BD, Schandler SL, Heinrich RL (1983) Signal detection and threshold measures to loud tones and radiant heat in chronic low back pain patients and cohort controls. Pain 16:245–252
de Heer EW, Gerrits MM, Beekman AT, Dekker J, van Marwijk HW, de Waal MW, Spinhoven P, Penninx BW, van der Feltz-Cornelis CM (2014) The association of depression and anxiety with pain: a study from nesda. PLoS ONE 9:e106907
Demyttenaere K, Bruffaerts R, Lee S, Posada-Villa J, Kovess V, Angermeyer MC, Levinson D, de Girolamo G, Nakane H, Mneimneh Z (2007) Mental disorders among persons with chronic back or neck pain: results from the world mental health surveys. Pain 129:332–342
Dickens C, McGowan L, Dale S (2003) Impact of depression on experimental pain perception: a systematic review of the literature with meta-analysis. Psychosom Med 65:369–375
Eisenberger NI (2012) The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nat Rev Neurosci 13:421–434
Fahland R, Kohlmann T, Hasenbring M, Feng Y, Schmidt C (2012) Which route leads from chronic back pain to depression? A path analysis on direct and indirect effects using the cognitive mediators catastrophizing and helplessness/hopelessness in a general population sample. Schmerz (Berlin, Germany) 26:685
Farasyn A, Lassat B (2016) Cross friction algometry (cfa): comparison of pressure pain thresholds between patients with chronic non-specific low back pain and healthy subjects. J Bodyw Mov Ther 20:224–234
First MB, Spitzer RL, Gibbon M, Williams BW (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (Scid-I/P). New York State Psychiatric Institute, New York
Foreman J (2014) A nation in pain: Healing our biggest health problem. Oxford University Press
Franklin JC, Aaron RV, Arthur MS, Shorkey SP, Prinstein MJ (2012) Nonsuicidal self-injury and diminished pain perception: the role of emotion dysregulation. Compr Psychiatry 53:691–700
Gaskin DJ, Richard P (2012) The economic costs of pain in the united states. J Pain 13:715–724
Germain SAS, Hooley JM (2013) Aberrant pain perception in direct and indirect non-suicidal self-injury: an empirical test of joiner’s interpersonal theory. Compr Psychiatry 54:694–701
Glenn JJ, Michel BD, Franklin JC, Hooley JM, Nock MK (2014) Pain analgesia among adolescent self-injurers. Psychiatry Res 220:921–926
Goesling J, Lin LA, Clauw DJ (2018) Psychiatry and pain management: at the intersection of chronic pain and mental health. Curr Psychiatry Rep 20:12
Gratz KL (2003) Risk factors for and functions of deliberate self-harm: an empirical and conceptual review. Clin Psychol Sci Pract 10:192–205
Greene SM (1989) The relationship between depression and hopelessness: implications for current theories of depression. Br J Psychiatry 154:650–659
Hayes AF (2012) PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf
Hooley JM, Ho DT, Slater J, Lockshin A (2010) Pain perception and nonsuicidal self-injury: a laboratory investigation. Personal Disord 1:170
Hser Y-I, Mooney LJ, Saxon AJ, Miotto K, Bell DS, Huang D (2017) Chronic pain among patients with opioid use disorder: results from electronic health records data. J Subst Abuse Treat 77:26–30
Hülsebusch J, Hasenbring MI, Rusu AC (2016) Understanding pain and depression in back pain: the role of catastrophizing, help-/hopelessness, and thought suppression as potential mediators. Int J Behav Med 23:251–259
Ilgen MA, Kleinberg F, Ignacio RV, Bohnert AS, Valenstein M, McCarthy JF, Blow FC, Katz IR (2013) Noncancer pain conditions and risk of suicide. JAMA Psychiat 70:692–697
Imamura M, Chen J, Matsubayashi SR, Targino RA, Alfieri FM, Bueno DK, Hsing WT (2013) Changes in pressure pain threshold in patients with chronic nonspecific low back pain. Spine 38:2098–2107
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the united states. Int J Methods Psychiatr Res 21:169–184
Kessler RC, Sampson NA, Berglund P, Gruber M, Al-Hamzawi A, Andrade L, Bunting B, Demyttenaere K, Florescu S, De Girolamo G (2015) Anxious and non-anxious major depressive disorder in the world health organization world mental health surveys. Epidemiol Psychiatr Sci 24:210–226
Klonsky ED, May AM (2015) The three-step theory (3st): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Ther 8:114–129
Klonsky ED, Oltmanns TF, Turkheimer E (2003) Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry 160:1501–1508
Koenig J, Thayer JF, Kaess M (2016) A meta-analysis on pain sensitivity in self-injury. Psychol Med 46:1597–1612
Kopp M, Gruzelier J (1989) Electrodermally differentiated subgroups of anxiety patients and controls. II: relationships with auditory, somatosensory and pain thresholds, agoraphobic fear, depression and cerebral laterality. Int J Psychophysiol 7:65–75
Kross E, Berman MG, Mischel W, Smith EE, Wager TD (2011) Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci U S A 108:6270–6275
Latremoliere A, Woolf CJ (2009) Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 10:895–926
Lerman SF, Rudich Z, Brill S, Shalev H, Shahar G (2015) Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosom Med 77:333–341
McCoy K, Fremouw W, McNeil DW (2010) Thresholds and tolerance of physical pain among young adults who self-injure. Pain Res Manag 15:371–377
International Association for the Study of Pain, Harold Merskey NB (ed) (1994) Classification of chronic pain: descriptions of chronic pain syndromés and definitions of pain terms. IASP Press, Seattle, Wash
O’Connor RC, Connery H, Cheyne WM (2000) Hopelessness: the role of depression, future directed thinking and cognitive vulnerability. Psychol Health Med 5:155–161
O’Connor RC, Fraser L, Whyte M-C, MacHale S, Masterton G (2009) Self-regulation of unattainable goals in suicide attempters: the relationship between goal disengagement, goal reengagement and suicidal ideation. Behav Res Ther 47:164–169
O’Connor RC, Kirtley OJ (2018) The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci 373:20170268
O’Connor RC, Rasmussen S, Hawton K (2010) Predicting depression, anxiety and self-harm in adolescents: the role of perfectionism and acute life stress. Behav Res Ther 48:52–59
Olesen AE, Andresen T, Staahl C, Drewes AM (2012) Human experimental pain models for assessing the therapeutic efficacy of analgesic drugs. Pharmacol Rev 64:722–779
Olie E, Guillaume S, Jaussent I, Courtet P, Jollant F (2010) Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord 120:226–230
Orbach I, Mikulincer M, King R, Cohen D, Stein D (1997) Thresholds and tolerance of physical pain in suicidal and nonsuicidal adolescents. J Consult Clin Psychol 65:646–652
Peters ML, Schmidt AJ (1992) Differences in pain perception and sensory discrimination between chronic low back pain patients and healthy controls. J Psychosom Res 36:47–53
Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ (2011) The columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 168:1266–1277
Racine M (2018) Chronic pain and suicide risk: a comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 87:269–280
Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCracken LM (2016) Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain 157:1472
Rodin G, Lo C, Mikulincer M, Donner A, Gagliese L, Zimmermann C (2009) Pathways to distress: the multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Soc Sci Med 68:562–569
Rodriguez-Raecke R, Ihle K, Ritter C, Muhtz C, Otte C, May A (2014) Neuronal differences between chronic low back pain and depression regarding long-term habituation to pain. Eur J Pain 18:701–711
Sansone RA, Wiederman MW, Sansone LA (1998) The self-harm inventory (shi): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol 54:973–983
Schmahl C, Bohus M, Esposito F, Treede R-D, Di Salle F, Greffrath W, Ludaescher P, Jochims A, Lieb K, Scheffler K (2006) Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry 63:659–666
Schmidt NB, Cook JH (1999) Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder. Behav Res Ther 37:313–323
International Society for the Study of Self-injury (2018) What is self-injury? Retrieved from: https://itriples.org/about-self-injury/what-is-self-injury
Strohmeier CW, Rosenfield B, DiTomasso RA, Ramsay JR (2016) Assessment of the relationship between self-reported cognitive distortions and adult adhd, anxiety, depression, and hopelessness. Psychiatry Res 238:153–158
Tang NK, Crane C (2006) Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med 36:575–586
Tantum B, Husband N (2009) Understanding repeated self-injury. Palgrave Macmilllian, New York, NY, USA
Thompson T, Correll CU, Gallop K, Vancampfort D, Stubbs B (2016) Is pain perception altered in people with depression? A systematic review and meta-analysis of experimental pain research. J Pain 17:1257–1272
Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB (2015) A classification of chronic pain for ICD-11. Pain 156:1003
Troister T, Holden RR (2010) Comparing psychache, depression, and hopelessness in their associations with suicidality: a test of shneidman’s theory of suicide. Personality Individ Differ 49:689–693
Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM (2017) Pain and psychology—a reciprocal relationship. Ochsner J 17:173–180
Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr (2010) The interpersonal theory of suicide. Psychol Rev 117:575–600
Velly AM, Mohit S (2018) Epidemiology of pain and relation to psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 87:159–167
Victor SE, Klonsky ED (2014) Correlates of suicide attempts among self-injurers: a meta-analysis. Clin Psychol Rev 34:282–297
Willoughby T, Heffer T, Hamza CA (2015) The link between nonsuicidal self-injury and acquired capability for suicide: a longitudinal study. J Abnorm Psychol 124:1110
Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:S2–S15
Funding
This work was partially funded by the Clinician Scientist Program of the University Arkansas for Medical Sciences and by P30 GM110702. No funding source had any role in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
RC receives research funding from Neuronetics and Janssen Pharmaceuticals and belongs to Roche’s speaker’s bureau. All the other authors declare no conflict of interests.
Rights and permissions
About this article
Cite this article
Kim, D.J., Job, A., Gokarakonda, S. et al. Synergistic effect of chronic pain and nonsuicidal self-harm on pain sensitivity. Eur Arch Psychiatry Clin Neurosci 272, 371–380 (2022). https://doi.org/10.1007/s00406-021-01283-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-021-01283-7