Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity

Spencer D. Dorn, Olafur S. Palsson, Syed I M Thiwan, Motoyori Kanazawa, W. Crawford Clark, Miranda A L Van Tilburg, Douglas A. Drossman, Yolanda Scarlett, Rona L. Levy, Yehuda Ringel, Michael D. Crowell, Kevin W. Olden, William E. Whitehead

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Abstract

Objective: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion - that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ("mild" pain) vs 5.2 ("weak" pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = -0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r = -0.26; p = 0.001) and BSI global score (r = -0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency. Conclusion: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.

Original languageEnglish (US)
Pages (from-to)1202-1209
Number of pages8
JournalGut
Volume56
Issue number9
DOIs
StatePublished - Sep 2007

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Irritable Bowel Syndrome
Pain Threshold
Psychology
Pain
Equipment and Supplies
Decision Theory
Visceral Pain
Descending Colon
Aptitude
Decision Support Techniques

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Dorn, S. D., Palsson, O. S., Thiwan, S. I. M., Kanazawa, M., Clark, W. C., Van Tilburg, M. A. L., ... Whitehead, W. E. (2007). Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. Gut, 56(9), 1202-1209. https://doi.org/10.1136/gut.2006.117390

Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. / Dorn, Spencer D.; Palsson, Olafur S.; Thiwan, Syed I M; Kanazawa, Motoyori; Clark, W. Crawford; Van Tilburg, Miranda A L; Drossman, Douglas A.; Scarlett, Yolanda; Levy, Rona L.; Ringel, Yehuda; Crowell, Michael D.; Olden, Kevin W.; Whitehead, William E.

In: Gut, Vol. 56, No. 9, 09.2007, p. 1202-1209.

Research output: Contribution to journalArticle

Dorn, SD, Palsson, OS, Thiwan, SIM, Kanazawa, M, Clark, WC, Van Tilburg, MAL, Drossman, DA, Scarlett, Y, Levy, RL, Ringel, Y, Crowell, MD, Olden, KW & Whitehead, WE 2007, 'Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity', Gut, vol. 56, no. 9, pp. 1202-1209. https://doi.org/10.1136/gut.2006.117390
Dorn, Spencer D. ; Palsson, Olafur S. ; Thiwan, Syed I M ; Kanazawa, Motoyori ; Clark, W. Crawford ; Van Tilburg, Miranda A L ; Drossman, Douglas A. ; Scarlett, Yolanda ; Levy, Rona L. ; Ringel, Yehuda ; Crowell, Michael D. ; Olden, Kevin W. ; Whitehead, William E. / Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. In: Gut. 2007 ; Vol. 56, No. 9. pp. 1202-1209.
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abstract = "Objective: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion - that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6{\%} vs 42.9{\%} were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ({"}mild{"} pain) vs 5.2 ({"}weak{"} pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = -0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r = -0.26; p = 0.001) and BSI global score (r = -0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency. Conclusion: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.",
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T1 - Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity

AU - Dorn, Spencer D.

AU - Palsson, Olafur S.

AU - Thiwan, Syed I M

AU - Kanazawa, Motoyori

AU - Clark, W. Crawford

AU - Van Tilburg, Miranda A L

AU - Drossman, Douglas A.

AU - Scarlett, Yolanda

AU - Levy, Rona L.

AU - Ringel, Yehuda

AU - Crowell, Michael D.

AU - Olden, Kevin W.

AU - Whitehead, William E.

PY - 2007/9

Y1 - 2007/9

N2 - Objective: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion - that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ("mild" pain) vs 5.2 ("weak" pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = -0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r = -0.26; p = 0.001) and BSI global score (r = -0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency. Conclusion: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.

AB - Objective: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion - that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ("mild" pain) vs 5.2 ("weak" pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = -0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r = -0.26; p = 0.001) and BSI global score (r = -0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency. Conclusion: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.

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