Original article
Aftermath of sexual abuse history on adult patients suffering from chronic functional pain syndromes: An fMRI pilot study

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Abstract

Objective

This preliminary study investigates the neural substrates of empathy-induced pain in multisomatoform pain patients “with vs. without” a history of sexual abuse during childhood.

Methods

Using functional magnetic resonance imaging (fMRI) and behavioral measurements, we compared eight abused with eight nonabused patients using an established empathy-for-pain paradigm.

Results

Higher activations in left lateral and medial superior frontal gyrus as well as a nonsignificant activation of the right supplementary motor area in abused patients were detected. The nonabused participants showed higher activation of left hippocampus. There was no significant difference in subjective pain ratings between the groups.

Conclusion

Although the number of participants still needs to be increased, our main findings mirror the clinical impression and support the notion of perturbed neuroprocessing of grievous stimuli in chronic pain patients with a history of sexual abuse.

Introduction

Neuroimaging research on how adverse childhood experiences affect human central pain processing is scarce. In the single inspiring functional magnetic resonance imaging (fMRI) study addressing this issue, Ringel et al. [1] reported the effects of general childhood abuse on brain responses to rectal distensions in 10 patients with irritable bowel syndrome. In contrast, we are especially interested in the processing of painful stimuli that are cognitive-affective, such as empathy for pain in a “self”-perspective, and not bodily, such as rectal distensions. Using an established empathetic-pain-inducing visual paradigm, our explorative pilot study intends to elucidate the more specific effects of sexual abuse during childhood on central pain processing in patients with pain-predominant multisomatoform disorder [1], [2]. On the back of Ringel's findings [1], we hypothesized increased activations in frontal and cingulate regions in chronic pain patients with a history of sexual abuse compared to those without such a history.

Section snippets

Materials and methods

The study was approved by the local ethics committee and conducted in accordance with the Declaration of Helsinki.

fMRI empathy task picture stimuli

The stimuli consisted of a series of pictures depicting human limbs in painful and nonpainful everyday situations (Fig. 1). Selected from a larger sample, the 120 pictures used in this study were grouped into four levels of pain (no, low, medium, high pain, 30 pictures each). For detailed explanation, see Jackson et al. [14]. Stimuli were presented using Presentation software (Neurobehavioral Systems) and back projected onto a screen at the head of the scanner bed.

Image preprocessing

The data analysis was performed with SPM5 (Statistical Parametric Mapping software). To equilibrate longitudinal magnetization, we discarded the first three images of each run. The preprocessing steps were (i) realigning and unwarping, (ii) coregistration of anatomical to functional images, (iii) segmentation and normalizing of the anatomical image to the standard stereotactic space (Montreal Neurological Institute), (iv) application of normalization transformation to the functional images, and

Results

Sexual abused participants showed higher activations in the left lateral and medial superior frontal gyrus as well as a nonsignificant response of the right supplementary motor area (SMA). The nonabused patients showed higher activation in the left hippocampus (Fig. 1 and Table 2). No significant group differences were seen in the subjective pain ratings (Table 1). As proven by analysis of covariance (ANCOVA) the level of depression and state anxiety (Table 1) did not influence the

Discussion

Recent neuroimaging research about neural correlates of traumatic experience focused on patients suffering from posttraumatic stress disorder (PTSD) [15], [16], [17]. Most of these studies showed higher BOLD activations in several brain areas, but not within the distinct frontal areas described in our study. In contrast to these studies, we specifically looked at patients with both pain-predominant multisomatoform disorder and a history of sexually aversive childhood experiences, but without

Acknowledgments

This work was supported by a KKF fund (Klinikum Rechts der Isar, Technische Universitaet Muenchen, Germany) to Michael Noll-Hussong and Afra Wohlschlaeger and a grant to Michael Noll-Hussong from the Deutsche Psychoanalytische Gesellschaft (DPG). The authors thank Paul Wheatley for critical remarks on the manuscript.

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