Psychophysiological Study of Pain Perception in Depressed Patients With Suicidal Risk

NCT04461327 | Terminated

• 1 other identifier: RECHMPL20_0157
• Study Type: interventional
• Target: 144
• Locations: 1 country
• Sites: 2

Brief Summary

Joiner's interpersonal theory of suicide postulates that the wish of death comes from feelings of perceived burdensomeness and thwarted belongingness. But, only people who have acquired the capability to kill themselves will attempt suicide. The acquired capability refers to a reduction of fear to death, and a higher pain tolerance. Indeed, to commit suicide involves to endure pain during the act. Thus, higher pain tolerance seems to be a necessary feature for suicidal act. Past studies have shown higher pain threshold and tolerance in suicidal patients, whatever the stimulus was (electric, thermic or mechanical), compared to patients without suicide history. Moreover, Caceda and colleagues demonstrated higher pain threshold in recent suicide attempters (suicidal act within 72h) compared with depressed patients. Five days after the initial evaluation, pain threshold of recent suicide attempters decreased to be similar to depressed patients with suicidal ideation. Therefore, it may exist a specific state during which the pain tolerance is increased. During this "hypoalgesic state" patients with suicidal ideation could attempt suicide to get relief from suffering. However, little is known about the specific mechanisms that are responsible for the higher pain threshold and tolerance in suicide attempters. Pain is a dynamic system that results from excitatory and inhibitory messages. The modification of one of these mechanisms could explain the higher tolerance in recent suicide attempters. Three of them are of particular interest:

1. 1.The conditioned pain modulation (CPM) is a modulatory pain mechanism. CPM works through descending pathway that reaches the spinal cord and modulates pain processing from the first nociceptive synapse.In recent suicidal patients, an increase of the CPM could explain higher pain tolerance.
2. 2.The "wind-up" mechanism is defined as the highest excitability of the second order nerve. Even if the stimulus remains stable, pain continuously raises. In recent suicide attempters, a reduction of this mechanism could explain higher pain tolerance.
3. 3.The threshold of Aδ and C nociceptors. If a nociceptive fiber is less excitable than the other, it would explain higher pain threshold.

Conditions

Major Depressive Disorder

Keywords

Pain; Pain modulation; Suicide; Affective touch

Outcome Measures

Primary Outcomes (1)

• Effectiveness of the conditioned pain modulation

  The criterion will be the average difference of perceived pain (CoVAS measure) before and after modulation, i.e. before and after the cold pressor task. It's postulated that recent suicidal patients will have a higher efficacity of CPM than past suicidal patients and depressed affective controls.

  During painful stimulations which are assessed 24 hours after the inclusion

Secondary Outcomes (9)

• Effectiveness of the Wind-up mechanism

  During painful stimulations which are assessed 24 hours after the inclusion

• Aδ and C fibers thresholds

  During painful stimulations which are assessed 24 hours after the inclusion

• Pleasantness associated with social touch

  During painful stimulations which are assessed 24 hours after the inclusion

• Emotional Reactivity Score

  At inclusion

• Emotional Regulation Score

  At inclusion

Study Arms (1)

Major Depressive patients

EXPERIMENTAL

3 groups: * Women having recently attempted suicide (less than 72 hours). * Women having a past suicide attempt (more than 72 hours). * Women without lifetime history of suicidal behaviour.

Behavioral: Painful stimulations of major depressive patients; Biological: Blood sample; Diagnostic Test: Clinical assessment; Behavioral: Social touch

Interventions

Painful stimulations of major depressive patients BEHAVIORAL

All three pain mechanisms will be tested in one session lasting 1h approximately. The mechanisms are tested in the following order: 1. Aδ and C threshold 2. Wind-up 3. CPM (more details in detailed description)

Major Depressive patients

Blood sample BIOLOGICAL

The blood test is made between 2 and 24 hours before the experimental procedure. The biological collection is made to measure medications' concentration if the patient takes antiepileptics and/or lithium, and to measure complete blood count (CBC).

Major Depressive patients

Clinical assessment DIAGNOSTIC_TEST

A clinical assessment will be made by a trained researcher. (more details in detailed description)

Major Depressive patients

Social touch BEHAVIORAL

Stroking

Major Depressive patients

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Woman;
• Being aged between 18 and 65 years;
• Currently meeting the DSM-5 major depressive episode criteria;
• Being able to understand the nature, purpose and methodology of the study and agreeing to cooperate during the assessments;
• Having signed informed consent;
• Being affiliated with a social security or equivalent.
• Recent attempters: women having recently attempted suicide (less than 72 hours)
• Past attempters: women having a past suicide attempt (more than 72 hours)
• Affective control: women without lifetime history of suicidal behaviour (affective control group).

You may not qualify if:

• Existence of current psychotic or mixed characteristics;
• Lifetime history of schizoaffective disorder or schizophrenia;
• Current substance dependence (within the last 6 months);
• Existence of mental retardation or serious medical comorbidity interfering with measures (HIV, diabetes, cancer, chronic inflammatory pathology, neurological disorder);
• Having taken painkillers within the last 24 hours preceding the evaluation;
• Existence of a usual or current treatment with analgesics or NSAIDs (daily analgesic treatment more than 3 months);
• Existence of a sensory or cognitive handicap;
• Pregnant or lactating woman.

Sponsors & Collaborators

• University Hospital, Montpellier: lead
• Clinea psychiatrie France: collaborator

Study Sites (2)

University Hospital of Montpellier

Montpellier, Occitanie, 34295, France

Location

Clinic La Lironde

Saint-Gély-du-Fesc, Occitanie, 34981, France

Location

MeSH Terms

Conditions

Depressive Disorder, Major; Pain; Suicide

Interventions

Blood Specimen Collection

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Self-Injurious Behavior; Behavioral Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Specimen Handling; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Punctures; Surgical Procedures, Operative; Investigative Techniques

Study Officials

• Emilie Olie, MD-PhD

  University Hospital, Montpellier

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Painful stimulations (see detailed description)

Study Record Dates

• First Submitted: July 2, 2020
• First Posted: July 8, 2020
• Study Start: November 25, 2020
• Primary Completion: February 21, 2024
• Study Completion: February 21, 2024
• Last Updated: March 25, 2025

Record last verified: 2025-03

Locations

FR (2)