Elsevier

Biological Psychiatry

Volume 68, Issue 5, 1 September 2010, Pages 442-450
Biological Psychiatry

Archival Report
Neural Correlates of Altered Pain Response in Women with Posttraumatic Stress Disorder from Intimate Partner Violence

https://doi.org/10.1016/j.biopsych.2010.03.034Get rights and content

Background

Intimate partner violence (IPV) is one of the most common causes of posttraumatic stress disorder (PTSD) in women. Women with IPV-related PTSD often experience comorbid chronic pain and pain-related disability. Despite the high comorbidity between PTSD and chronic pain, recent evidence suggests that male veterans with combat-related PTSD report decreased sensitivity to experimental pain. The aim of this study was to examine the neurobehavioral correlates of experimental pain in women with IPV-related PTSD.

Methods

Functional magnetic resonance neuroimaging data were collected during an event-related experimental pain paradigm that was administered twice to 23 women with IPV-related PTSD and 15 age-, race- and education-comparable nontraumatized control women. Brief thermal heat stimuli were repeatedly applied to the left volar forearm, and subjects rated the perceived temperature intensity with a button-box.

Results

Women with IPV-related PTSD relative to nontraumatized control women showed: 1) increased activation of right middle insula and right dorsolateral prefrontal cortex during initial painful stimulation, and 2) subsequent decrease in subjective intensity ratings with repeated exposure to pain, which was accompanied by attenuation of activation within right anterior insula that was associated with avoidance symptoms of PTSD.

Conclusions

These results suggest that women with IPV-related PTSD show dysregulated functional brain activity during pain processing, which might drive maladaptive coping mechanisms, such as avoidance and numbing.

Section snippets

Subjects

Thirty-one women experiencing current post-traumatic stress related to IPV were enrolled. In this study, IPV was defined as physical and/or sexual abuse by a male romantic partner within the past 5 years. Each subject fulfilled diagnostic criteria for full (21F) or partial (2F) PTSD according to a structured clinical interview for DSM-IV (35) and scored >50 on the Clinician Administered PTSD Scale (CAPS) (36). The PTSD-IPV women were excluded if they were currently in an abusive relationship or

Psychological Measures

Women with IPV-related PTSD had significantly higher scores on the Beck Depression Inventory (t = 10.7, p < .01), State-Trait Anxiety Inventory (both state and trait) (t values > 3.0, p values < .01), Childhood Trauma Questionnaire (t values > 2.2, p values < .05), and Dissociative Experiences Scale—Traumatic (t = 3.0, p < .01), as indicated in Table 1. Differences in psychological measures are consistent with prior literature (32, 46).

Temperature Ratings

As hypothesized, repeated measures analysis of variance

Discussion

To our knowledge this is the first report describing the neural correlates of experimental pain perception in women with IPV-related PTSD. The results of the current experiment indicate that women with IPV-related PTSD displayed altered subjective experience and brain activation to experimental heat stimuli, which is consistent with findings from a study with men and combat-related PTSD (14). Specifically, we found that in women with IPV-related PTSD, repeated exposure to aversive sensory

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