Are Patients With Schizophrenia Insensitive to Pain? A Reconsideration of the Question (Bonnot, Anderson, Cohen, Willer, & Tordjman, 2009)

Bonnot, O., Anderson, G., Cohen, D., Willer, J. C., & Tordjman, S. (2009). Are Patients With Schizophrenia Insensitive to Pain? A Reconsideration of the Question. The clinical journal of pain, 25(3), 244-252.

OK… one thing I have to say is that this is the 3^rd or 4^th review paper I have gone through about pain in psychotics… I am starting to feel that much of the information is redundant and will only do a brief notation on this article…

International Association for the Study of Pain (IASP): "(J)ust because someone cannot verbally communicate their state of being doesn't mean they are not experiencing pain and requires no interventions." Schizophrenia, for instance, is a type of mental disease that could involve communication problems and cognitive impairments.

This article reviewed 57 selected articles which could be classified as case reports, clinical and epidemiologic studies, experimental studies and previous review papers.

Discussion

Insensitivity or less reactivity?

I believe the authors' opinion is that the reported pain insensitivity is a result of altered mode of pain expression rather than endogenous analgesia. In addition, the authors also mentioned the assessment problems: the pain measures were not comparable, psychophysical methods are potentially unreliable and, even with signal detection theory, what is intended to measure the sensory discrimination might end up measuring some other processes.

Biochemical Dysfunction?

The opioid and N-methyl-D-aspartate theories of Schizophrenia have been proposed. However, research concerning both hypotheses provided conflicting results.

Decreased behavioral pain expression and stress vulnerability model

The experience of pain results in stress. In ordinary people, the reactions to pain stimuli could be released through normal pain behavior, psychologically or physically. Patients with schizophrenia, on the other hand, can not release the invoked stress through normal reaction channel. As a result, stress might get built up and results in the worsening of psychotic conditions.