The pressure pain threshold can help identify adolescents at high risk of self-harm

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Disclosure:
Cummins reports that while conducting the study he received funding from the Medical Research Council and the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust. One study author reports that outside of the work submitted, he has received grants from the National Institute of Health Research. The other authors do not report any relevant financial information.

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The pressure pain threshold could be a novel biomarker to identify a high risk of self-harm in adolescents, according to the results of a cross-sectional study published in JAMA Network Open.

“Advances have been made in machine learning and functional imaging to identify suicidal adolescents, but there are few recognized biological, clinical, or psychological risk factors that could be used clinically with confidence.” Tatum M. Cummins, MSc, from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, UK, and colleagues wrote. “Contemporary theories of suicidal behavior posit that individuals who exhibit suicidal behavior must develop an acquired ability to do so; an increased pain tolerance is proposed as part of this. There is some evidence that individuals who injure themselves may experience altered pain perception, but the causes remain unclear and the effects of self-harm on somatosensory sensitivity without pain are even less well understood. “

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To fill this research gap, researchers used quantitative sensory tests to measure somatosensory function in 64 children and adolescents aged 13 to 17 (53% girls; 78% in care homes; mean age 16.34 years) with no underlying health issues to be assessed in care, grouped by the number of self-harm episodes in the past year, as well as to compare the somatosensory profiles of these individuals with the community control participants to assess associations with the frequency or frequency of self-harm. They recruited participants from local care facilities in the UK, as well as schools and youth groups in the UK between January 2019 and March 2020, using intellectual disability, autism spectrum disorder or a recent serious injury as exclusion criteria. The researchers used a standardized quantitative sensory test protocol to determine basic somatosensory function. They calculated associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription drugs. They also assessed possible associations between self-harm and certain types of tests, such as: B. painful or not painful.

The results showed significant pain hyposensitivity in subjects with five or more incidences of self-harm compared to those in community control after adjusting for age, gender, and prescription medication. After making a similar adjustment, the researchers found that hyposensitivity extended to non-painful stimuli. They related most of the observed variance to the pressure pain threshold.

“How pain sensitivity changes with age and whether these sensory changes diminish over time with changing frequency or the cessation of self-harm is unknown,” wrote Cummins and colleagues. “Future studies should investigate whether a pain sensitivity test can predict the onset of self-harm and completed suicides. In addition, these results could be extended to longitudinal studies in adults who are currently or previously self-injured to investigate whether sensory hyposensitivity is lost in adolescents and how sensory sensitivity manifests itself in adulthood. “

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