Central Processing of Noxious Somatic Stimuli in Patients With Irritable Bowel Syndrome Compared With Healthy Controls
Open accessAbstract
OBJECTIVE: To compare a central analgesic mechanism known as diffuse noxious inhibitory controls (DNIC) using somatic test stimuli and somatic conditioning stimuli, (CS) in irritable bowel syndrome (IBS) patients and healthy controls. METHODS: Participants were 48 premenopausal females (27 with IBS), mean age of 29 years. The phasic heat test stimulus (peak temperature, 50 degrees C) was applied to the left palm. The DNIC effect, which measured reductions in average pain ratings (APR) during counter irritation (submersion of the participant's right hand in painful 12 degrees C circulating water) compared with baseline, was compared between groups. In addition, a second, counterbalanced, CS protocol (right hand submerged in nonpainful 32 degrees C circulating water) was performed. Differences in APR between the 2 counterirritation protocols were compared between groups to control for nonspecific effects known to influence DNIC. Psychologic measures and cardiovascular reactivity were also assessed. RESULTS: IBS patients demonstrated smaller DNIC than controls (P=0.011, repeated measures analysis of variance), and greater state-anxiety, depression, catastrophizing, and anger-out expression (P<0.05). Group differences in DNIC were enhanced after controlling for nonspecific effects occurring during the nonpainful CS, and for psychologic measures (P=0.001, repeated measures analysis of covariance). There were no group differences in age, cardiovascular reactivity, APR, or pain ratings for the 12 degrees C CS. DISCUSSION: These data demonstrate deficient DNIC in IBS. This is the first study to adequately control for alternative explanations of pain reduction during counterirritation. Only by controlling for nonspecific effects can evidence of deficient DNIC be attributed to dysregulation in endogenous analgesic mechanisms.
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Some patients with IBS have compromised central inhibitory regulation of visceral and somatic stimuli.
“Some patients with IBS have compromised central inhibitory regulation of visceral and somatic stimuli.35”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [35]
The Discussion concludes that IBS patients showed compromised inhibitory regulation of somatic pain stimuli. It also reports an earlier finding of impaired inhibition during visceral stimulation, but cautions that distraction, hypervigilance, or peripheral gut sensitization could explain that finding; this paper therefore does not establish compromised central inhibition of visceral stimuli. (LLM, conf=0.86)
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- Authors
- Heymen, S., Maixner, W., Whitehead, W. E., Klatzkin, R. R., Mechlin, B., & Light, K. C.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Heymen, Steve
- Whitehead, William E.
- Venue
- The Clinical Journal of Pain
- Published
- 2010-02
- Volume
- 26
- Issue
- 2
- Pages
- 104-109
- ISSN
- 0749-8047 (ISSN-L)
- PMC
- PMC4321817
- OpenAlex
- W2010829771
- Cited by
- 82
- References
- 164
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 9 · 2020: 6 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 9 · 2014: 7 · 2013: 12 · 2012: 7
- FWCI
- 9.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (P01NS045685)
- National Institute of Dental and Craniofacial Research (U01DE017018)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- irritable bowel syndrome, diffuse noxious inhibitory control, endogenous analgesia, counter-irritation, pain catastrophizing, state anxiety, depression, anger expression, cardiovascular reactivity, non-specific effects
- MeSH terms
- Adult, Analysis of Variance, Blood Pressure, Female, Heart Rate, Hot Temperature, Humans, Hyperalgesia, Physical Stimulation, Psychometrics, Surveys and Questionnaires, Pain Threshold, Irritable Bowel Syndrome
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