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

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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

DOI 10.1016/s0016-5085(98)70099-x

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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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Method
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“In addition, whilst only approximately half of IBS patients appear to exhibit lowered rectal sensory thresholds to balloon distension (Whitehead and Palsson, 1998; Posserud et al., 2007), almost all patients (70%) show hypersensitivity elsewhere in the gastrointestinal tract, especially in the jejunum (Francis et al.”
Background
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Authors: WHITEHEAD, W., & PALSSON, O.
Affiliations: University of North Carolina at Chapel Hill (US)
Eastern Virginia Medical School (US)
ORCID: PALSSON, O
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 1998-11
Volume: 115
Issue: 5
Pages: 1263-1271
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1016/s0016-5085(98)70099-x
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: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception.

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