Neural Correlates of Altered Pain Response in Women with Posttraumatic Stress Disorder from Intimate Partner Violence

Background: Intimate partner violence (IPV) is one of the most common causes of posttraumatic stress disorder (PTSD) in women. Women with IPV-related PTSD often experience comorbid chronic pain and pain-related disability. Despite the high comorbidity between PTSD and chronic pain, recent evidence suggests that male veterans with combat-related PTSD report decreased sensitivity to experimental pain. The aim of this study was to examine the neurobehavioral correlates of experimental pain in women with IPV-related PTSD. Methods: Functional magnetic resonance neuroimaging data were collected during an event-related experimental pain paradigm that was administered twice to 23 women with IPV-related PTSD and 15 age-, race- and education-comparable nontraumatized control women. Brief thermal heat stimuli were repeatedly applied to the left volar forearm, and subjects rated the perceived temperature intensity with a button-box. Results: Women with IPV-related PTSD relative to nontraumatized control women showed: 1) increased activation of right middle insula and right dorsolateral prefrontal cortex during initial painful stimulation, and 2) subsequent decrease in subjective intensity ratings with repeated exposure to pain, which was accompanied by attenuation of activation within right anterior insula that was associated with avoidance symptoms of PTSD. Conclusions: These results suggest that women with IPV-related PTSD show dysregulated functional brain activity during pain processing, which might drive maladaptive coping mechanisms, such as avoidance and numbing.