Karl-Jürgen Bär1, Silke Boettger2, Gerd Wagner2, Christine Wilsdorf2, Uwe Jens Gerhard2, Michael K Boettger2, Bernhard Blanz2, Heinrich Sauer2. 1. Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany. Electronic address: Karl-Juergen.Baer@med.uni-jena.de. 2. Drs. Bär, Boettger, Wagner, Sauer and Ms. Wilsdorf are with the Department of Psychiatry; Drs. Gerhard and Blanz are with the Department of Child and Adolescent Psychiatry; and Dr. Boettger is with the Institute of Physiology, Friedrich-Schiller-University, Jena, Germany.
Abstract
OBJECTIVES: The underlying mechanisms of reduced pain perception in anorexia nervosa (AN) are unknown. To gain more insight into the pathology, the authors investigated pain perception, autonomic function, and endocrine parameters before and during successful treatment of adolescent AN patients. METHOD: Heat pain perception was assessed in 15 female adolescent AN patients and matched controls. Results were correlated with autonomic and endocrine parameters (free triiodothyronine, free cortisol). Autonomic function was studied using heart rate variability and pupillary light reflex assessment. To investigate the influence of therapy on these parameters, data were obtained at three different time points. RESULTS: Heat pain thresholds were significantly increased in the acute state and decreased after weight had been regained for 6 months. Similarly, an increased parasympathetic tone was present in the acute state only. The relative amplitude of the pupillary light reflex showed a positive correlation to pain thresholds over time and predicted disease progression. In addition, the authors found a negative correlation between increased pain thresholds and low free cortisol. CONCLUSION: Increased pain thresholds are associated with increased parasympathetic tone and a hypothyroid state in AN. This may either indicate common central mechanisms or suggest a causative interaction.
OBJECTIVES: The underlying mechanisms of reduced pain perception in anorexia nervosa (AN) are unknown. To gain more insight into the pathology, the authors investigated pain perception, autonomic function, and endocrine parameters before and during successful treatment of adolescent AN patients. METHOD: Heat pain perception was assessed in 15 female adolescent AN patients and matched controls. Results were correlated with autonomic and endocrine parameters (free triiodothyronine, free cortisol). Autonomic function was studied using heart rate variability and pupillary light reflex assessment. To investigate the influence of therapy on these parameters, data were obtained at three different time points. RESULTS: Heat pain thresholds were significantly increased in the acute state and decreased after weight had been regained for 6 months. Similarly, an increased parasympathetic tone was present in the acute state only. The relative amplitude of the pupillary light reflex showed a positive correlation to pain thresholds over time and predicted disease progression. In addition, the authors found a negative correlation between increased pain thresholds and low free cortisol. CONCLUSION: Increased pain thresholds are associated with increased parasympathetic tone and a hypothyroid state in AN. This may either indicate common central mechanisms or suggest a causative interaction.
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