Markedly Reduced Thermal Pain Perception ina Schizoaffective Patient with Tardive Dyskinesia

Several case reports have described stories of schizophrenia patients reporting no discomfort in response to several medicalconditions which normally elicit pain. Comparatively, experimental studies performed on pain perception in schizophrenia havenot documented hypoalgesic responses that are as frank as those reported in these clinical cases. Here, we report the case of a femalepatient with schizoaffective disorder, who displayed markedly reduced pain perception during an experimental heat pain paradigm.Compared to a large group of healthy volunteers that we tested in 3 previous studies using the same psychophysical procedure, theexperimental temperature required to induce moderate pain was radically increased in this patient (𝑧-score = 3.6). The patienthad mild psychiatric symptoms and had insight into her symptoms. She had drug-induced dyskinetic symptoms. This case reportillustrates that it is possible to observe marked reductions in pain perception in schizophrenia patients tested in experimentalsettings but that the phenomenon is relatively rare. Regardless of the exact nature of pain indifference in schizophrenia, it can delaydiagnosis and treatment of medical problems in these patients. Future studies in the field will need to pay attention to drug-inducedextrapyramidal symptoms.