Somatoform pain: a developmental theory and translational research review.
ABSTRACT Somatoform pain is a highly prevalent, debilitating condition and a tremendous public health problem. Effective treatments for somatoform pain are urgently needed. The etiology of this condition is, however, still unknown. On the basis of a review of recent basic and clinical research, we propose one potential mechanism of symptom formation in somatoform pain and a developmental theory of its pathogenesis. Emerging evidence from animal and human studies in developmental neurobiology, cognitive-affective neuroscience, psychoneuroimmunology, genetics, and epigenetics, as well as that from clinical and treatment studies on somatoform pain, points to the existence of a shared neural system that underlies physical and social pain. Research findings also show that nonoptimal early experiences interact with genetic predispositions to influence the development of this shared system and the ability to regulate it effectively. Interpersonal affect regulation between infant and caregiver is crucial for the optimal development of these brain circuits. The aberrant development of this shared neural system during infancy, childhood, and adolescence may therefore ultimately lead to an increased sensitivity to physical and social pain and to problems with their regulation in adulthood. The authors critically review translational research findings that support this theory and discuss its clinical and research implications. Specifically, the proposed theory and research review suggest that psychotherapeutic and/or pharmacological interventions that foster the development of affect regulation capacities in an interpersonal context will also serve to more effectively modulate aberrantly activated neural pain circuits and thus be of particular benefit for the treatment of somatoform pain.
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ABSTRACT: Current theories suggest that physical pain and social rejection share common neural mechanisms, largely by virtue of overlapping functional magnetic resonance imaging (fMRI) activity. Here we challenge this notion by identifying distinct multivariate fMRI patterns unique to pain and rejection. Sixty participants experience painful heat and warmth and view photos of ex-partners and friends on separate trials. FMRI pattern classifiers discriminate pain and rejection from their respective control conditions in out-of-sample individuals with 92% and 80% accuracy. The rejection classifier performs at chance on pain, and vice versa. Pain- and rejection-related representations are uncorrelated within regions thought to encode pain affect (for example, dorsal anterior cingulate) and show distinct functional connectivity with other regions in a separate resting-state data set (N=91). These findings demonstrate that separate representations underlie pain and rejection despite common fMRI activity at the gross anatomical level. Rather than co-opting pain circuitry, rejection involves distinct affective representations in humans.Nature Communications 11/2014; 5:5380. DOI:10.1038/ncomms6380 · 10.74 Impact Factor
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ABSTRACT: The aim of the present study was to examine the intra-and interpersonal emotion regulation of patients with somatic symptom disorders (SSDs) during interactions with significant others (i.e., romantic partners). We presented two case couples for analysis.The first couple consisted of a patient with SSD and his healthy partner, whereas the second couple consisted of two healthy partners. The couples underwent an interpersonal experiment that involved baseline, anger and relaxation tasks. During each task, partners' cutaneous facial temperature, heart rate and skin conductance levels were measured simultaneously. Participants' trait-emotion regulation, state-affect reports for self and other, and attachment styles were also examined. The experimental phases were successful in creating variations in physiological processes and affective experience. As expected, emotion regulation difficulties predicted higher increase in the course of temperature at each phase. Besides, the patient showed restricted awareness and reflection to emotions despite his higher autonomic activity compared to healthy controls. Both partners of the first couple revealed limited ability in understanding the other's emotions, whereas the second couple performed relatively better in that domain. The temperature variations between the patient and his partner were significantly correlated while the correlations of temperature changes between the second couple were negligible except anger task. The study supported the merits of an embodied interpersonal approach in clinical studies. The tentative results of the cases were discussed in the light of findings in emotion regulation and attachment research.Frontiers in Psychology 03/2015; 6. DOI:10.3389/fpsyg.2015.00068 · 2.80 Impact Factor
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ABSTRACT: Oxytocin (OT), associated with affiliation and social bonding, social salience, and stress/pain regulation, may play a role in the pathophysiology of stress-related disorders, including menstrually-related mood disorders (MRMD's). Adverse impacts of early life sexual abuse (ESA) on adult attachment, affective regulation, and pain sensitivity suggest ESA-related OT dysregulation in MRMD pathophysiology. We investigated the influence of ESA on plasma OT, and the relationship of OT to the clinical phenomenology of MRMD's. Compared to MRMD women without ESA (n=40), those with ESA (n=20) displayed significantly greater OT [5.39pg/mL (SD, 2.4) vs. 4.36pg/mL (SD, 1.1); t (58)=-2.26, p=03]. In women with ESA, OT was significantly, inversely correlated with premenstrual psychological and somatic symptoms (r's=-.45 to -.64, p's<.05). The relationship between OT and premenstrual symptomatology was uniformly low and non-significant in women without ESA. In women with ESA, OT may positively modulate MRMD symptomatology. Copyright © 2015. Published by Elsevier B.V.Biological psychology 04/2015; DOI:10.1016/j.biopsycho.2015.04.003 · 3.47 Impact Factor