title: Neural correlates of antinociception in borderline personality disorder.
abstract: BACKGROUND
  A characteristic feature of borderline personality disorder (BPD) is self-injurious behavior in conjunction with stress-induced reduction of pain perception. Reduced pain sensitivity has been experimentally confirmed in patients with BPD, but the neural correlates of antinociceptive mechanisms in BPD are unknown. We predicted that heat stimuli in patients with BPD would activate brain areas concerned with cognitive and emotional evaluation of pain.
  
  
  OBJECTIVE
  To assess the psychophysical properties and neural correlates of altered pain processing in patients with BPD.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Twelve women with BPD and self-injurious behavior and 12 age-matched control subjects.
  
  
  METHODS
  Psychophysical assessment and blood oxygen level-dependent functional magnetic resonance imaging during heat stimulation with fixed-temperature heat stimuli and individual-temperature stimuli adjusted for equal subjective pain in all the participants.
  
  
  METHODS
  Blood oxygen level-dependent functional magnetic resonance imaging signal changes during heat pain stimulation.
  
  
  RESULTS
  Patients with BPD had higher pain thresholds and smaller overall volumes of activity than controls in response to identical heat stimuli. When the stimulus temperature was individually adjusted for equal subjective pain level, overall volumes of activity were similar, although regional patterns differed significantly. Patient response was greater in the dorsolateral prefrontal cortex and smaller in the posterior parietal cortex. Pain also produced neural deactivation in the perigenual anterior cingulate gyrus and the amygdala in patients with BPD.
  
  
  CONCLUSIONS
  The interaction between increased pain-induced response in the dorsolateral prefrontal cortex and deactivation in the anterior cingulate and the amygdala is associated with an antinociceptive mechanism in patients with BPD.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany. christian.schmahl@zi-mannheim.de
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Esposito
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Salle
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greffrath
authors.forename: Petra
authors.initials: P
authors.lastname: Ludaescher
authors.forename: Anja
authors.initials: A
authors.lastname: Jochims
authors.forename: Klaus
authors.initials: K
authors.lastname: Lieb
authors.forename: Klaus
authors.initials: K
authors.lastname: Scheffler
authors.forename: Juergen
authors.initials: J
authors.lastname: Hennig
authors.forename: Erich
authors.initials: E
authors.lastname: Seifritz
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D004056:Differential Threshold / Q000502:physiology; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology; D006358:Hot Temperature; D006801:Humans; D008279:Magnetic Resonance Imaging; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold / Q000502:physiology; D010812:Physical Stimulation; D017397:Prefrontal Cortex / Q000503:physiopathology; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000503:physiopathology; D013697:Thermosensing / Q000502:physiology
chemical_list: D010100:Oxygen