Chronic pain syndromes and borderline personality.

Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, USA.
Innovations in Clinical Neuroscience 01/2012; 9(1):10-4.
Source: PubMed

ABSTRACT The assessment and management of chronic pain is challenging and, according to the existing literature, oftentimes associated with various forms of psychopathology, including borderline personality disorder. Since 1994, eight studies have explored the relationship between chronic pain syndromes and borderline personality disorder. In averaging the prevalence rates in these studies, 30 percent of participants with chronic pain harbor this Axis II disorder. Related studies suggest that individuals with borderline personality disorder report higher levels of pain than those without this personality dysfunction; older, rather than younger, patients with borderline personality disorder are more likely to have higher pain levels; patients with borderline personality disorder in remission use significantly less pain medications; medical disability status in chronic pain does not necessarily differ between those with versus without borderline personality disorder; and the first-degree relatives of individuals with borderline personality disorder demonstrate statistical coaggregation with somatoform pain disorder. Why might chronic pain demonstrate associations with borderline personality disorder? Perhaps chronic pain is simply another manifestation of the inability of individuals with borderline personality disorder to self-regulate (i.e., the inability to regulate pain). In addition, pain symptoms may function as an interpersonal means of eliciting caring responses from others. Regardless, the assessment and treatment implications of these comorbid patients suggest a challenging scenario for both mental health and primary care clinicians.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In both primary care and consultative practices, patients presenting with fibromyalgia (FM) often have other medically unexplained somatic symptoms and are ultimately diagnosed as having central sensitization (CS). Central sensitization encompasses many disorders where the central nervous system amplifies sensory input across many organ systems and results in myriad symptoms. A pragmatic approach to evaluate FM and related symptoms, including a focused review of medical records, interviewing techniques, and observations, is offered here, giving valuable tools for identifying and addressing the most relevant symptoms. At the time of the clinical evaluation, early consideration of CS may improve the efficiency of the visit, reduce excessive testing, and help in discerning between typical and atypical cases so as to avoid an inaccurate diagnosis. Discussion of pain and neurophysiology and sensitization often proves helpful.
    04/2015; 6(2):e0020. DOI:10.5041/RMMJ.10204
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Individuals with borderline personality disorder (BPD), compared to controls, report a relative absence of acute pain. In contrast, BPD is overrepresented among chronic pain patients, suggesting they experience a relative excess of chronic pain. To date, this "pain paradox" has been only partially explored; no study has examined both acute and chronic pain in the same sample. In addition, previous research has not fully examined the effect of nonsuicidal self-injury (NSSI) on either acute or chronic pain experience in BPD. Undergraduates (N = 206), oversampled for those high in BPD features, completed a Cold Pressor Task (CPT), rating their pain every 15 s over a maximum of 4 min. Following the CPT, participants completed measures of BPD features, NSSI history, past-year pain, and perceived pain tolerance. Results did not support the expected negative association between BPD features and acute pain. Multilevel modeling revealed an interaction of BPD features and NSSI history on CPT pain ratings: Among individuals in the no-NSSI group, BPD features were associated with greater acute pain. Among individuals in the NSSI group, BPD features were not significantly associated with acute pain. Results for past-year pain indicated that BPD features were associated with greater past-year pain regardless of NSSI history. This finding, coupled with the difference in the association of BPD features and acute pain between the NSSI and no-NSSI groups provides tentative evidence that the combination of BPD features and NSSI history, among nonclinical samples, is linked to a pain paradox. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 02/2015; 6(2). DOI:10.1037/per0000112 · 3.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients' pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach.
    Neuropsychiatric Disease and Treatment 01/2014; 10:2291-7. DOI:10.2147/NDT.S70555 · 2.15 Impact Factor


Available from