Emotional numbing in PTSD is associated with lower amygdala reactivity to pain. 2022

Nachshon Korem, and Or Duek, and Ziv Ben-Zion, and Antonia N Kaczkurkin, and Shmuel Lissek, and Temidayo Orederu, and Daniela Schiller, and Ilan Harpaz-Rotem, and Ifat Levy
Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511, USA. Nachshon.Korem@yale.edu.

Posttraumatic stress disorder (PTSD) is associated with altered pain perception, namely increased pain threshold and higher pain response. While pain consists of physiological and affective components, affective components are often overlooked. Similar patterns of increased threshold-high response in PTSD were shown in response to emotional stimuli, i.e., emotional numbing. As both emotional numbing and pain processing are modulated by the amygdala, we aimed to examine whether individuals diagnosed with PTSD show lower amygdala activation to pain compared with combat controls, and whether the amygdala responses to pain correlates with emotional numbing. To do so, two independent samples of veterans (original study: 44 total (20 PTSD); conceptual replication study: 40 total (20 PTSD)) underwent threat conditioning, where a conditioned stimulus (CS+; visual stimulus) was paired with an unconditioned stimulus (US; electric-shock). We contrasted the amygdala activity to the CS + US pairing with the CS+ presented alone and correlated it with emotional numbing severity. In both samples, the PTSD group showed a robust reduction in amygdala reactivity to shock compared to the Combat Controls group. Furthermore, amygdala activation was negatively correlated with emotional numbing severity. These patterns were unique to the amygdala, and did not appear in comparison to a control region, the insula, a pivotal region for the processing of pain. To conclude, amygdala response to pain is lower in individuals with PTSD, and is associated with emotional numbing symptoms. Lower amygdala reactivity to mild pain may contribute to the "all-or-none" reaction to stressful situations often observed in PTSD.

UI MeSH Term Description Entries
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D010146 Pain An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS. Suffering, Physical,Ache,Pain, Burning,Pain, Crushing,Pain, Migratory,Pain, Radiating,Pain, Splitting,Aches,Burning Pain,Burning Pains,Crushing Pain,Crushing Pains,Migratory Pain,Migratory Pains,Pains, Burning,Pains, Crushing,Pains, Migratory,Pains, Radiating,Pains, Splitting,Physical Suffering,Physical Sufferings,Radiating Pain,Radiating Pains,Splitting Pain,Splitting Pains,Sufferings, Physical
D004644 Emotions Those affective states which can be experienced and have arousing and motivational properties. Feelings,Regret,Emotion,Feeling,Regrets
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000679 Amygdala Almond-shaped group of basal nuclei anterior to the INFERIOR HORN OF THE LATERAL VENTRICLE of the TEMPORAL LOBE. The amygdala is part of the limbic system. Amygdaloid Body,Amygdaloid Nuclear Complex,Amygdaloid Nucleus,Archistriatum,Corpus Amygdaloideum,Intercalated Amygdaloid Nuclei,Massa Intercalata,Nucleus Amygdalae,Amygdalae, Nucleus,Amygdaloid Bodies,Amygdaloid Nuclear Complices,Amygdaloid Nuclei, Intercalated,Amygdaloid Nucleus, Intercalated,Amygdaloideum, Corpus,Amygdaloideums, Corpus,Archistriatums,Complex, Amygdaloid Nuclear,Complices, Amygdaloid Nuclear,Corpus Amygdaloideums,Intercalata, Massa,Intercalatas, Massa,Intercalated Amygdaloid Nucleus,Massa Intercalatas,Nuclear Complex, Amygdaloid,Nuclear Complices, Amygdaloid,Nuclei, Intercalated Amygdaloid,Nucleus, Amygdaloid,Nucleus, Intercalated Amygdaloid
D013313 Stress Disorders, Post-Traumatic A class of traumatic stress disorders with symptoms that last more than one month. Moral Injury,Neuroses, Post-Traumatic,PTSD,Post Traumatic Stress Disorder,Post-Traumatic Stress Disorders,Acute Post-Traumatic Stress Disorder,Chronic Post-Traumatic Stress Disorder,Delayed Onset Post-Traumatic Stress Disorder,Neuroses, Posttraumatic,Posttraumatic Stress Disorders,Stress Disorder, Post Traumatic,Stress Disorders, Posttraumatic,Acute Post Traumatic Stress Disorder,Chronic Post Traumatic Stress Disorder,Delayed Onset Post Traumatic Stress Disorder,Injury, Moral,Moral Injuries,Neuroses, Post Traumatic,Post Traumatic Stress Disorders,Post-Traumatic Neuroses,Post-Traumatic Stress Disorder,Posttraumatic Neuroses,Posttraumatic Stress Disorder,Stress Disorder, Post-Traumatic,Stress Disorder, Posttraumatic
D014728 Veterans Former members of the armed services. Veteran

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