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HYPOACTIVITY OF VENTROMEDIAL PREFRONTAL CORTEX IN PATIENTS WITH SOMATOFORM PAIN DISORDER - A CONTROLLED FMRI STUDY | |
| Contact: Harald Gündel, MD Phone: 08 941 404316 Email: h.guendel@LRZ.TU-MUENCHEN.DE Embargoed until: March 6, 2005 |
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Vancouver, BC, Canada - There is evidence that prefrontal brain areas predominantly exert inhibitory influences on pain perception in humans. A subregion (medial frontal cortex) is necessary for so-called emotional and/or cognitive reflective awareness, which is known to be reduced in patients with somatization disorder. We therefore hypothesized that during pain stimulation patients suffering from chronic somatoform pain (i.e., pain with a predominantly "psychogenic" origin) would show a reduced prefrontal brain activation compared to control subjects. Thirteen right handed women (mean age 47.4 yrs.) fulfilling DSM-IV criteria for somatoform pain disorder were consecutively recruited from an interdisciplinary pain clinic as well as 13 age-matched healthy control subjects (mean age 47.3 yrs.). Functional neuroimaging was performed in a 1.5 Tesla magnetic resonance scanner (fMRI) scanner. Thermal noxious stimuli were repetitively administered to the subjects left forearm. The group analysis of fMRI data revealed one region significantly hypoactivated in subjects with somatoform pain disorder compared to healthy controls: the right ventromedial orbitofrontal cortex. In contrast, thermal noxious thermal noxious heat stimulation resulted in significant increased activation in left parahippocampal gyrus ("pain memory"), secondary somatosensory (sensory pain perception) and left anterior insular cortex (interoception) . Our finding of a hypoactivation of the right ventromedial prefrontal cortex in somatoform pain disorder may indeed indicate a diminished top-down mode of inhibition of pain perception in patients with so-called "psychogenic" pain (i.e., somatoform pain disorder). Thus we could show that even "psychogenic" pain has an underlying biological substrate. | |
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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Vicki White, Managing Editor for Manuscript Production,
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