Cited by 314Gastrointestinal motility and disordersPsychosomatic Disorders and Their TreatmentsFibromyalgia and Chronic Fatigue Syndrome Research

Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception.

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WHITEHEAD, W, PALSSON, O·1998·Gastroenterology

Abstract

Background & aims Rectal pain sensitivity has been called a biological marker for irritable bowel syndrome, but this conclusion may be premature. This article is a critical review of the evidence for psychological influences on perception.Methods The world literature accessible through Index Medicus from 1973 to 1997 was systematically reviewed.Results Evidence favoring a biological basis for pain sensitivity is that two thirds of patients report pain at abnormally low thresholds of rectal distention despite normal somatic pain thresholds. Pain thresholds are not correlated with anxiety or depression. Evidence favoring psychological influences on perception is that patients with the irritable bowel syndrome rate even sham distentions as more painful, and when perception tests that minimize psychological influences are used, they have normal sensory thresholds. Also, stress alters sensory thresholds. Sensitization by repeated distention has been cited as evidence of a biological basis for hyperalgesia, but it is not unique to patients with irritable bowel. Brain imaging shows that different regions are activated by painful distention in patients with irritable bowel syndrome, but this is consistent with psychological influences on perception.Conclusions Psychological factors influence pain thresholds in patients with the irritable bowel syndrome. Two cognitive traits, selective attention to gastrointestinal sensations and disease attribution, may account for increased pain sensitivity.

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  • Recent investigations have found that mindfulness meditation induces changes in neural circuits implicated in interoception and emotion regulation, while improving attentional control.

    “Recent investigations have found that mindfulness meditation induces changes in the activation of neural circuits implicated in interoception (awareness of stimuli originating inside the body (21)) and emotion regulation (22,23), while improving attentional control (24–27).”

    From Mindfulness training reduces the severity of irritable bowel syndrome in women: Results of a randomized controlled trial (2011) · cites this paper as [25]

    Citation (21) is attached to the definition of interoception, not to the findings about mindfulness meditation. The paper’s “Selective Attention and Disease Attribution” section discusses becoming aware of gastrointestinal sensations, which supports awareness of internal sensations in that specific context. It does not define interoception or address awareness of stimuli originating throughout the body; no page number is available in our copy. (LLM, conf=0.76)

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Research works printed but not linked: 6

  1. Metivier S, Delvaux D, Louvel D, Lagier E, Fioramonti J, Bueno L, Frexinos J. Influence of stress on sensory thresholds to rectal distension in healthy volunteers (abstr). Gastroenterology 1996; 110:A717.
  2. Palsson OS, McCommons JJ, Burnett CK, Bradley LA, Whitehead WE. Relationship between bowel sensations: pain, urge to defecate and rectal fullness in iritable bowel syndrome (IBS) patients and healthy subjects (abstr). Gastroenterology 1995;108: A663.
  3. Bradley L, Richter J, Scarinci IC, Haile JE, Schan CA. Mechanisms of altered pain perception in non-cardiac chest pain patients (abstr). Gastroenterology 1993;104:A482.
  4. Mertz H, Fass R, Hirsh T, Yan-Go F, Mayer EA. Amitryptiline for functional dyspepsia: effect on symptoms, gastic sensitivity and sleep (abstr). Gastroenterology 1995;108:A649.
  5. Bell AM, Pemberton JH, Camilleri M, Hanson RB, Zinsmeister AR. The effect of acute stress on rectal tone and anal sphincter pressure (abstr). Gastroenterology 1989;96:A38.
  6. Crowell M, Musial F, Kollmannsperger P, Mueller J, Orr WC. Association of rectal tone during stress with sensitivity to disten- sion in the irritable bowel syndrome (abstr). Am J Gastroenterol 1993;88:1572.

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Authors
WHITEHEAD, W., & PALSSON, O.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Eastern Virginia Medical School (US)
Venue
Gastroenterology
Publisher
Elsevier BV
Published
1998-11
Volume
115
Issue
5
Pages
1263-1271
ISSN
0016-5085 (ISSN-L)
OpenAlex
W2150287168
Cited by
314
References
85
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 12 · 2015: 10 · 2014: 8 · 2013: 6 · 2012: 10
FWCI
2.84
Type
journal article
Language
en
Open access
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • National Institutes of Health (2k05mh000133-17)
  • National Institute of Mental Health (KO5 MH00133)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031369, R01 DK31369)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
irritable bowel syndrome, pain threshold, rectal distension, hyperalgesia, anxiety, depression, stress, sensitization, neuroimaging, selective attention, disease attribution, biomarkers
MeSH terms
Colonic Diseases, Functional, Humans, Pain, Rectum, Biomarkers, Pain Threshold

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