Psychological pain: A review of evidence
Journal of Psychiatric ResearchPublished 26 May 2006
Steven Mee, Blynn G. Bunney, Christopher Reist, Steven G. Potkin, William E. Bunney
Citations177
SJR quartileQ1
SJR score1.49
SNIP1.15
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Clinical and neuroimaging evidence relevant to psychological pain and its interaction with nociceptive pathways may provide novel clues to the understanding and treatment of depression and other psychiatric illnesses are reviewed.
Abstract
This paper defines a symptom construct termed psychological pain and reviews clinical and neuroimaging evidence relevant to it. The psychological pain associated with severe depression is often perceived as worse than any physical pain that the individual has experienced and could be a critical component of suicidality that could be systematically assessed in potentially suicidal patients. Converging evidence from brain imaging studies suggests overlapping patterns of brain activation induced by both psychological pain and by physical pain. Future research on the role of psychological pain and its interaction with nociceptive pathways may provide novel clues to the understanding and treatment of depression and other psychiatric illnesses.
Keywords
MedicineNeuroscience
ScienceEmpathy for Pain Involves the Affective but not Sensory Components of Pain
3,920 Citations2004Tania Singer, Ben Seymour +4 more
Only that part of the pain network associated with its affective qualities, but not its sensory qualities, mediates empathy, suggesting that the neural substrate for empathic experience does not involve the entire "pain matrix".
ScienceDoes Rejection Hurt? An fMRI Study of Social Exclusion
3,797 Citations2003Naomi I. Eisenberger, Matthew D. Lieberman +1 more
Archives of Internal MedicineDepression and Pain Comorbidity
3,421 Citations2003Matthew J. Bair, R.L. Robinson +2 more
A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.
European Journal of PainHuman brain mechanisms of pain perception and regulation in health and disease
3,103 Citations2005A. Vania Apkarian, M. Catherine Bushnell +2 more
This research highlights the importance of knowing the carrier and removal status of canine coronavirus, as a source of infection for other animals, not necessarily belonging to the same breeds.
American Journal of PsychiatryReciprocal Limbic-Cortical Function and Negative Mood: Converging PET Findings in Depression and Normal Sadness
2,399 Citations1999Helen S. Mayberg, Mario Liotti +9 more
Reciprocal changes involving subgenual cingulate and right prefrontal cortex occur with both transient and chronic changes in negative mood, suggesting that these regional interactions are obligatory and probably mediate the well-recognized relationships between mood and attention seen in both normal and pathological conditions.
Neurophysiologie CliniqueFunctional imaging of brain responses to pain. A review and meta-analysis (2000)
2,148 Citations2000Roland Peyron, B. Laurent +1 more
Data suggest that hemodynamic responses to pain reflect simultaneously the sensory, cognitive and affective dimensions of pain, and that the same structure may both respond to pain and participate in pain control.
Nature NeuroscienceSubcortical and cortical brain activity during the feeling of self-generated emotions
2,125 Citations2000António R. Damásio, Thomas J. Grabowski +5 more
The hypothesis that the process of feeling emotions requires the participation of brain regions that are involved in the mapping and/or regulation of internal organism states is tested, indicating the close relationship between emotion and homeostasis.
SciencePlacebo-Induced Changes in fMRI in the Anticipation and Experience of Pain
2,006 Citations2004Tor D. Wager, James K. Rilling +7 more
fMRI experiments found that placebo analgesia was related to decreased brain activity in pain-sensitive brain regions, including the thalamus, insula, and anterior cingulate cortex, and was associated with increased activity during anticipation of pain in the prefrontal cortex, providing evidence that placebos alter the experience of pain.
JAMAThe Journal of Neuropsychiatry and Clinical Neurosciences
1,238 Citations1992Virginia M. Bowden
The journal tends to concentrate on those aspects of disease that are medically observable rather than strictly inferential, so, for schizophrenia, one finds articles about electroencephalographic patterns and attentional states and higher cortical states.
Trends in Cognitive SciencesWhy rejection hurts: a common neural alarm system for physical and social pain
1,228 Citations2004Naomi I. Eisenberger, Matthew D. Lieberman
Evidence suggesting that the anterior cingulate cortex plays a key role in the physical-social pain overlap is reviewed and it is suggested that the physical and social pain circuitry might share components of a broader neural alarm system.
BrainDissociable neural responses to facial expressions of sadness and anger
1,220 Citations1999James Blair, J S Morris +3 more
Functional neuroimaging results provide evidence for dissociable, but interlocking, systems for the processing of distinct categories of negative facial expression.
ScienceDissociating Pain from Its Anticipation in the Human Brain
1,149 Citations1999Alexander Ploghaus, Irene Tracey +5 more
Functional magnetic resonance imaging in healthy humans was applied to dissociate neural activation patterns associated with acute pain and its anticipation to find sites within the medial frontal lobe, insular cortex, and cerebellum distinct from, but close to, locations mediating pain experience itself.
Clinical Journal of PainChronic Pain-Associated Depression: Antecedent or Consequence of Chronic Pain? A Review
1,065 Citations1997David A. Fishbain, Robert M. Cutler +2 more
Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP and at pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS.
American Journal of PsychiatryNeuroanatomical correlates of happiness, sadness, and disgust
758 Citations1997Richard D. Lane, Eric M. Reiman +3 more
This study identifies regions of the brain that participate in happiness, sadness, and disgust, regions that distinguish between positive and negative emotions, and regions that depend on both the elicitor and valence of emotion or their interaction.
Proceedings of the National Academy of SciencesThe subjective experience of pain: Where expectations become reality
751 Citations2005Tetsuo Koyama, John G. McHaffie +2 more
Results confirm that a mental representation of an impending sensory event can significantly shape neural processes that underlie the formulation of the actual sensory experience and provide insight as to how positive expectations diminish the severity of chronic disease states.
American Journal of PsychiatryBrain activity during transient sadness and happiness in healthy women
746 Citations1995Mark S. George, Terence A. Ketter +4 more
Transient sadness and happiness in healthy volunteer women are accompanied by significant changes in regional brain activity in the limbic system, as well as other brain regions, which have implications for understanding the neural substrates of both normal and pathological emotion.
Archives of General PsychiatryUsing Chronic Pain to Predict Depressive Morbidity in the General Population
613 Citations2003Maurice M. Ohayon, Alan F. Schatzberg
The presence of CPPCs increases the duration of depressive mood and patients seeking consultation for a CPPC should be systematically evaluated for depression.
Journal of NeurophysiologyCortical Representation of the Sensory Dimension of Pain
600 Citations2001Robert K. Hofbauer, Pierre Rainville +2 more
A double dissociation of cortical modulation indicates a relative specialization of the sensory and the classical limbic cortical areas in the processing of the Sensory and affective dimensions of pain.
GastroenterologyRegional cerebral activity in normal and pathological perception of visceral pain
550 Citations1997DH Silverman, J. Munakata +4 more
The perception of acute rectal pain is associated with activation of the anterior cingulate cortex in healthy subjects, and patients with IBS show an aberrant brain activation pattern both during noxious rectal distention and during the anticipation ofrectal pain.
Journal of NeuroendocrinologyChronic Pain, Chronic Stress and Depression: Coincidence or Consequence?
497 Citations2001Gordon Blackburn-Munro, Ruth E. Blackburn-Munro
The possible involvement of the HPA axis in the aetiology of both chronic pain and clinical depression is discussed, and a strategy for the development of novel pharmacotherapies is suggested.
Annual Review of PsychologyThe Psychology and Neurobiology of Suicidal Behavior
476 Citations2004Thomas E. Joiner, Jessica Brown +1 more
It is concluded that from both neurobiological and psychological perspectives, extant research findings converge on the view that two general categories of risk for suicide can be identified: dysregulated impulse control and propensity to intense psychological pain.
NeuronDirect Activation of the Ventral Striatum in Anticipation of Aversive Stimuli
459 Citations2003Jimmy Jensen, Anthony R. McIntosh +4 more
The data suggest that the ventral striatum, a crucial element of the brain "reward" system, is directly activated in anticipation of aversive stimuli.
Journal of NeuroscienceDoes Anticipation of Pain Affect Cortical Nociceptive Systems?
459 Citations2002Carlo Adolfo Porro, Patrizia Baraldi +5 more
FMRI results suggest that the activity of cortical nociceptive networks may be directly influenced by cognitive factors, and provide evidence for top-down mechanisms, triggered by anticipation, modulating cortical systems involved in sensory and affective components of pain even in the absence of actual noxious input.
Biological PsychiatryDifferential limbic–cortical correlates of sadness and anxiety in healthy subjects: implications for affective disorders
436 Citations2000Mario Liotti, Helen S. Mayberg +4 more
These findings are interpreted within a model in which sadness and anxiety are represented by segregated corticolimbic pathways, where a major role is played by selective dorsal cortical deactivations during sadness, and ventral cortical deactivateations in anxiety.
NeuropsychologiaNeural correlates of feeling sympathy
407 Citations2002Jean Decety, Thierry Chaminade
Results are consistent with a model of feeling sympathy that relies on both the shared representation and the affective networks, and Interestingly, this network was not activated when subjects watched inappropriate social behavior.
NeuroImageCerebral activation during hypnotically induced and imagined pain
406 Citations2004Stuart Derbyshire, Matthew G. Whalley +2 more
Functional magnetic resonance imaging revealed significant changes during this hypnotically induced pain experience within the thalamus and anterior cingulate, insula, prefrontal, and parietal cortices, providing the first direct experimental evidence in humans linking specific neural activity with the immediate generation of a pain experience.
Acta Psychiatrica ScandinavicaLife events and affective disorders
362 Citations2003Eugene S. Paykel
Research in life events and affective disorders and affectsive disorders is summarized to summarize research in life Events and Affective disorders.
NeuroImageA Functional Anatomy of Anticipatory Anxiety
343 Citations1999Phyllis Chua, Michael Krams +3 more
Findings support the role of paralimbic structures as neural substrates of anticipatory anxiety and the failure to demonstrate behavioral and neurophysiological changes with the distractor task may reflect the modest increases in anxiety with the shock, the relatively simple distractionor task, and small sample size.
European Journal of NeuroscienceAttention to pain localization and unpleasantness discriminates the functions of the medial and lateral pain systems
340 Citations2005B Kulkarni, Deborah E. Bentley +7 more
The results indicate the importance of attentional effects on the pattern of nociceptive processing in the brain and provide the first clear demonstration, within a single experiment, of a major division of function within the neural pain matrix.
American Journal of PsychiatryFunctional Neuroanatomy of Grief: An fMRI Study
288 Citations2003Harald Gündel, Mary‐Frances O'Connor +3 more
Grief is mediated by a distributed neural network that subserves affect processing, mentalizing, episodic memory retrieval, processing of familiar faces, visual imagery, autonomic regulation, and modulation/coordination of these functions.
Human Psychopharmacology Clinical and ExperimentalThe epidemiology of pain in depression
266 Citations2004J.-P. L�pine, Mike Briley
Over 75% of depressed patients in primary care complain of painful physical symptoms such as headache, stomach pain, neck and back pain aswell as non‐specific generalized pain, which predicts a greater severity and a less favourable outcome of depression with a poorer health‐related quality of life.
NeuroImageReal-time fMRI of temporolimbic regions detects amygdala activation during single-trial self-induced sadness
258 Citations2003Stefan Posse, Daniel A. Fitzgerald +5 more
This novel real-time fMRI technology is applicable to a wide range of neuroscience studies, particularly those of the limbic system, and to neuropsychiatric conditions, such as depression, in which pathology of the amygdala has been implicated.
Suicide and Life-Threatening BehaviorMental Pain: A Multidimensional Operationalization and Definition
256 Citations2003Israel Orbach, Mario Mikulincer +2 more
Mental pain is conceptualized as a perception of negative changes in the self and its functions that are accompanied by negative feelings and can be meaningfully applied to the study of different mental states, life conditions, and transitions in life.
Neuroscience LettersAnticipatory coping of pain expressed in the human anterior cingulate cortex: a positron emission tomography study
235 Citations1999Jen‐Chuen Hsieh, Sharon Stone‐Elander +1 more
The right-preponderant expression of the changes in the ACC supports the hypothesis of a preferential role of the non-dominant hemisphere in negative emotional processing and illustrates a neurophysiological process underlying the modulation of attention to pain.
CortexEngagement of Lateral and Medial Prefrontal Areas in the Ecphory of Sad and Happy Autobiographical Memories
232 Citations2003Hans J. Markowitsch, Marie Vandekerckhove +2 more
The findings point to the importance of the orbitofrontal cortex for affect-laden information processing and to the existence of distinct neural nets for the re-activation of positively and negatively viewed autobiographic episodes.
NeuroImageSame or different? Neural correlates of happy and sad mood in healthy males
229 Citations2005Ute Habel, Martina Klein +3 more
Negative and positive moods reveal distinct cortical activation foci within a common neural network, probably making the difference between qualitatively different emotional feelings.
Biological PsychiatryGender differences in regional cerebral blood flow during transient self-induced sadness or happiness
225 Citations1996Mark S. George, Terence A. Ketter +3 more
Women activated a significantly wider portion of their limbic system than did men during transient sadness, despite similar self-reported changes in mood, which may aid in understanding gender differences with respect to emotion and mood.
NeuroreportThe functional neuroanatomy of major depression
223 Citations1998Mario Beauregard, Jean‐Maxime Leroux +5 more
An fMRI study using an emotional activation paradigm revealed that passive viewing of the emotionally laden film clip produced a significantly greater activation in the left medial prefrontal cortex and in the right cingulate gyrus in depressed patients than in normal control subjects.
Suicide and Life-Threatening BehaviorMental Pain and Its Relationship to Suicidality and Life Meaning
214 Citations2003Israel Orbach, Mario Mikulincer +2 more
In two studies, a relationship between a newly developed measure of mental pain--the Orbach & Mikulincer Mental Pain Scale, 2002 (OMMP) and suicidal behavior and life meaning were examined and confirmed both propositions.
PainSuicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk
194 Citations2004Michael T. Smith, Robert R. Edwards +2 more
The need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain, is highlighted.
Journal of Epidemiology & Community HealthMidlife suicide risk, partner’s psychiatric illness, spouse and child bereavement by suicide or other modes of death: a gender specific study
182 Citations2005Esben Agerbo
American Journal of Public HealthSuicide and Marital Status in the United States, 1991–1996: Is Widowhood a Risk Factor?
169 Citations2002Jason B. Luoma, Jane L. Pearson
This study finds that as many as 1 in 400 White and African American widowed men aged 20-35 years will die by suicide in any given year (compared with 1 in 9000 married men in the general population).
Human Brain MappingGender differences in regional cerebral activity during sadness
163 Citations2000Frank Schneider, Ute Habel +3 more
Results point to differential regional cerebral correlates of emotional experience in males and females, which is suggestive of a more focal and subcortical processing of sadness in men.
American Journal of PsychiatryRegional Brain Activity in Women Grieving a Romantic Relationship Breakup
159 Citations2004Arif Najib, Jeffrey P. Lorberbaum +3 more
During acute grief, subjects showed brain activity changes in the cerebellum, anterior temporal cortex, insula, anterior cingulate, and prefrontal cortex, consistent with the hypothesis, and further imaging studies are needed to understand the relationship between normal sadness, grief, and depression.
GutFunctional abdominal pain, psychiatric illness, and life events.
154 Citations1988Francis Creed, Tom Craig +1 more
Patients undergoing appendicectomy, attending a gastroenterology clinic or admitted to hospital after self-poisoning have been examined using the same reliable measures to establish whether life events and psychiatric illness preceded abdominal pain.
PubMedThe association of chronic pain and suicide.
148 Citations1999David A. Fishbain
A review of known suicide risk factors from other populations indicated that CP populations commonly exhibit other suicide risk Factors, and psychiatric examiners should consider CP to be a potential suicide risk factor.
Proceedings of the National Academy of SciencesBrain correlates of subjective reality of physically and psychologically induced pain
142 Citations2005Tuukka T. Raij, Jussi Numminen +3 more
Findings support the view that information about sensory-discriminative characteristics of pain contributes to the SRP, and suggest the medial prefrontal cortex is a likely area to contribute to such source monitoring.
Suicide and Life-Threatening BehaviorParental Bereavement After Suicide and Accident: A Comparative Study
137 Citations1995Monique Séguin, Alain Lesage +1 more
Parental bereavement after suicide appears to differ in several ways from other types of bereavement and appears to happen more often in vulnerable families.
Journal of Neurology Neurosurgery & PsychiatryPrevalence and impact of depression and pain in neurology outpatients
133 Citations2003Linda Williams
Depression and pain are common in newly referred neurology outpatients and have substantial negative effects on patients’ physical and mental health.
GastroenterologyBrain Response to Visceral Aversive Conditioning: A Functional Magnetic Resonance Imaging Study
129 Citations2005L Yágüez, Steven J. Coen +7 more
Functional magnetic resonance imaging of the human brain is used to study the neuroanatomic network involved in aversive conditioning of visceral pain and, thus, anticipation to show that actual and anticipated visceral pain elicit similar cortical responses.
PainThe anterior cingulate cortex contains distinct areas dissociating external from self-administered painful stimulation: a parametric fMRI study
93 Citations2005C Mohr, Ferdinand Binkofski +3 more
Data support the functional segregation of the human ACC: the posterior ACC may be involved in the prediction of the sensory consequences of pain‐related action, the midcingulate cortex in pain intensity coding and the perigenual ACC is related to the onset uncertainty of the impending stimuli.
PubMedHopelessness: an indicator of suicidal risk.
93 Citations1975Mária Kovács, Aaron T. Beck +1 more
Clinical Journal of PainCompleted Suicide in Chronic Pain
76 Citations1991David A. Fishbain, Myron Goldberg +2 more
Journal of Affective DisordersSeverity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype
74 Citations2003Philip B. Mitchell
Findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.
Behaviour Research and TherapyHopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples
73 Citations2001Thomas E. Joiner, Robert A. Steer +4 more
Analysis of structural equation modeling analyses on large samples of psychiatric outpatients and Air Force cadets found findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome.
Current Treatment Options in NeurologySuicide in neurologic illness
71 Citations2002David B. Arciniegas, C. Alan Anderson
Identification and aggressive treatment of psychiatric problems, especially depression, as well as reduction of modifiable suicide risk factors among patients with neurologic illness is needed to reduce the risk of attempted and completed suicide in this population.
Suicide and Life-Threatening BehaviorPsychache and Suicidality in Adult Mood Disordered Outpatients in Brazil
68 Citations2003Marcelo T. Berlim, Betina S. Mattevi +5 more
This study determined whether an index closely related to psychache, psychological quality of life, would display a special and resilient association to suicidality among 60 adult psychiatric outpatients in Brazil.
PubMedMental pain and suicide.
63 Citations2003Israel Orbach
Different models of mental pain (emotional pain, psychological pain, psychache), based on a content analysis of Styron's book Darkness visible: A memoir of madness, describe mental pain as an inner turmoil of hostile forces are described.
European Journal of PainImaging of acute versus pathological pain in humans
61 Citations2004Juergen Lorenz, K. L. Casey
Comparison of PET and subtracted scans obtained during painful heating of normal skin from scans during equally intense but normally non‐painful heating of capsaicin‐treated skin reveals the specific activation of a medial thalamic pathway to limbic forebrain structures during pain originating in the chemically sensitised skin.
DepressionEffects of self-generated sad mood on regional cerebral activity: A PET study in normal subjects
59 Citations1996Michael Gemar, Shitij Kapur +3 more
A statistical comparison of the images revealed that sad mood was associated with a decrease in rCBF in the left dorsolateral prefrontal, left medial prefrontal, and left temporal cortex; no increase in activity was noted in this comparison.
Journal of NeuropsychiatryNeural and Endocrine Correlates of Sadness In Women: Implications for Neural Network Regulation of HPA Activity
43 Citations2004William E. Ottowitz, Darin D. Dougherty +4 more
Journal of NeuropsychiatryRegional Cerebral Blood Flow Changes During Visually Induced Subjective Sadness in Healthy Elderly Persons
31 Citations2003Sergio Paradiso, Robert G. Robinson +3 more
The specific findings associated with sad affect were contingent on the comparison stimuli content (scenes or human faces), not affect (i.e., comparison with neutral or happy conditions).
Brain TopographyVirtual Pain Stimulation of Allodynia Patients Activates Cortical Representation of Pain and Emotions: A Functional MRI Study
30 Citations2005Takahiro Ushida, Tatsunori Ikemoto +7 more
Neural correlates of affect processing in allodynia patients and healthy controls with the aid of virtual tactile stimulation indicate involvement of an emotional component of pain perception in all odynia patients.
American Journal of PsychotherapyThe Use of Suicidal Motives in the Psychotherapy of Attempted Suicides
25 Citations1975Maria Kovags, Aaron T. Beck +1 more
Patients' reasons for their suicide attempts were categorized and related to levels of hopelessness and depression and the findings are discussed in the light of the psychotherapy of suicidal individuals.
Psychiatry and Clinical NeurosciencesClinical evaluation of suicide risk
22 Citations1995Antoon A. Leenaars
It is concluded that all assessment and prediction of suicide risk ultimately depends on the skill of the clinician.
Clinical Nursing ResearchMessages of Psychiatric Patients who Attempted or Committed Suicide
20 Citations1994Sharon M. Valente
Clinicians' recognition of themes in suicide messages and improves the estimation of suicide risk among psychiatric patients are enhanced and the stigma attached to suicide is described.
Journal of NeuropsychiatryNeural and Endocrine Correlates of Sadness In Women: Implications for Neural Network Regulation of HPA Activity
19 Citations2004W. E. Ottowitz
PsychosomaticsThe Pain-Depression Relationship
12 Citations2002David A. Fishbain
The Argyll-Robertson pupil is not very sensitive as a sign of neurosyphilis, and the authors can now see that it also is not specific, so the complex diagnosis of neuroSyphilis becomes even a little more difficult with this knowledge.
Suicide and Life-Threatening BehaviorA Bibliography of Suicide Notes: 1856–1979
10 Citations1979Edwin S. Shneidman
A bibliography of suicide notes, arranged chronologically, from 1856 to the present (1979) is presented without comment.
Brain Research ProtocolsRegression analysis utilizing subjective evaluation of emotional experience in PET studies on emotions
9 Citations2005Sargo Aalto, Esa Wallius +5 more
Preliminary evidence of a linear association between the neural responses related to amusement and sadness and the self-evaluated intensity of the emotional experience in several regions involved in the emotional response is given.
Journal of NeuropsychiatryRegional Cerebral Blood Flow Changes During Visually Induced Subjective Sadness in Healthy Elderly Persons
8 Citations2003Sergio Paradiso
…