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1.
Gastroenterology ; 166(6): 976-994, 2024 06.
Article in English | MEDLINE | ID: mdl-38325759

ABSTRACT

Chronic visceral pain is one of the most common reasons for patients with gastrointestinal disorders, such as inflammatory bowel disease or disorders of brain-gut interaction, to seek medical attention. It represents a substantial burden to patients and is associated with anxiety, depression, reductions in quality of life, and impaired social functioning, as well as increased direct and indirect health care costs to society. Unfortunately, the diagnosis and treatment of chronic visceral pain is difficult, in part because our understanding of the underlying pathophysiologic basis is incomplete. In this review, we highlight recent advances in peripheral pain signaling and specific physiologic and pathophysiologic preclinical mechanisms that result in the sensitization of peripheral pain pathways. We focus on preclinical mechanisms that have been translated into treatment approaches and summarize the current evidence base for directing treatment toward these mechanisms of chronic visceral pain derived from clinical trials. The effective management of chronic visceral pain remains of critical importance for the quality of life of suffers. A deeper understanding of peripheral pain mechanisms is necessary and may provide the basis for novel therapeutic interventions.


Subject(s)
Chronic Pain , Visceral Pain , Humans , Visceral Pain/physiopathology , Visceral Pain/therapy , Visceral Pain/diagnosis , Visceral Pain/etiology , Chronic Pain/therapy , Chronic Pain/physiopathology , Chronic Pain/diagnosis , Chronic Pain/psychology , Animals , Quality of Life , Signal Transduction
3.
Int J Mol Sci ; 21(12)2020 Jun 17.
Article in English | MEDLINE | ID: mdl-32560291

ABSTRACT

The management of chronic visceral pain related to Inflammatory Bowel Diseases or Irritable Bowel Syndrome is still a clinical problem and new therapeutic strategies continue to be investigated. In the present study, the efficacy of a pomegranate decoction and of its polysaccharide and ellagitannin components in preventing the development of colitis-induced abdominal pain in rats was evaluated. After colitis induction by 2,4-dinitrobenzenesulfonic acid (DNBS), the pomegranate decoction (300 mg kg-1), polysaccharides (300 mg kg-1), and ellagitannins (45 mg kg-1) were orally administered for 14 days. Repeated treatment with decoction reduced visceral hypersensitivity in the colitic animals both at 7 and 14 days. Similar efficacy was shown by polysaccharides, but with lower potency. Ellagitannins administered at dose equivalent to decoction content showed higher efficacy in reducing the development of visceral pain. Macroscopic and microscopic evaluations performed on the colon 14 days after the damage showed that all three preparations reduced the overall amount of mast cells, the number of degranulated mast cells, and the density of collagen fibers in the mucosal stroma. Although ellagitannins seem to be responsible for most of the beneficial effects of pomegranate on DNBS-induced colitis, the polysaccharides support and enhance its effect. Therefore, pomegranate mesocarp preparations could represent a complementary approach to conventional therapies for promoting abdominal pain relief.


Subject(s)
Anti-Inflammatory Agents/pharmacology , Colitis/complications , Plant Extracts/pharmacology , Pomegranate/chemistry , Visceral Pain/etiology , Animals , Anti-Inflammatory Agents/chemistry , Biomarkers , Disease Models, Animal , Immunohistochemistry , Plant Extracts/chemistry , Rats , Retreatment , Treatment Outcome , Visceral Pain/diagnosis , Visceral Pain/drug therapy
4.
Prim Care ; 46(3): 319-333, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31375184

ABSTRACT

The intent of this article is to help clinicians to have practical knowledge and skills related to both assessment and pharmacotherapy of chronic pain in the seriously ill patients. Treating patients with chronic pain and progressive disease should include assessment of "total pain" (physical, psychological, and spiritual suffering) and the care givers as part of treatment team. Effective management of chronic pain starts with thorough assessment and diagnosis of the pain syndrome. A worldwide consensus endorses use of multimodal approach and opioid pharmacotherapy as the mainstay approach to moderate to severe pain in cancer and pain associated with serious illness.


Subject(s)
Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Pain Management/methods , Primary Health Care/organization & administration , Analgesics/therapeutic use , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Chronic Pain/diagnosis , Chronic Pain/therapy , Critical Illness , Drug Therapy, Combination , Humans , Neuralgia/diagnosis , Neuralgia/therapy , Nociceptive Pain/diagnosis , Nociceptive Pain/therapy , Pain Measurement , Palliative Care/methods , Patient Care Planning , Visceral Pain/diagnosis , Visceral Pain/therapy
5.
Neurogastroenterol Motil ; 31(9): e13664, 2019 09.
Article in English | MEDLINE | ID: mdl-31194287

ABSTRACT

BACKGROUND: Visceral hypersensitivity plays a key role in the pathophysiology of chronic visceral pain like irritable bowel syndrome (IBS), which is significantly more prevalent in women. Possible sex differences in visceral sensitivity remain poorly studied. We assessed sex differences in visceral sensitivity and their association with subclinical symptoms, trait anxiety, and chronic stress in a large sample of healthy men and women. METHODS: In 280 young healthy volunteers (50% female), visceral sensory and pain thresholds were determined using rectal balloon distensions. Gastrointestinal (GI) symptoms, chronic stress, and trait anxiety as IBS-related risk factors were assessed with questionnaires. Men and women were compared regarding visceral sensitivity and multiple regression analyses were conducted to evaluate the predictive value of sex and risk factors for visceral sensitivity. Subgroups with high, intermediate, and low sensitivity were compared regarding psychological and biological characteristics. KEY RESULTS: Men and women did not differ in sensory or pain thresholds or in IBS-related risk factors. In multiple regression analyses, no predictor of visceral sensitivity could be identified. While sensitivity subgroups differed in sensory and pain thresholds, the proportions of men and women were comparable, and groups did not differ in IBS-related risk factors. CONCLUSIONS AND INFERENCES: Despite the large sample size, we found no evidence supporting sex differences in visceral sensitivity. At least in healthy young volunteers, our findings suggest that sex, GI symptoms, anxiety, or chronic stress do not contribute to altered visceral sensitivity.


Subject(s)
Pain Measurement/methods , Pain Threshold/physiology , Sex Characteristics , Visceral Pain/diagnosis , Visceral Pain/physiopathology , Adult , Cohort Studies , Female , Humans , Male , Pain Measurement/psychology , Pain Threshold/psychology , Visceral Pain/psychology , Young Adult
6.
Clin Transl Gastroenterol ; 10(4): e00034, 2019 04.
Article in English | MEDLINE | ID: mdl-31009405

ABSTRACT

OBJECTIVES: Fecal microbiota transfer (FMT) is suggested as a potential treatment for patients with irritable bowel syndrome (IBS). We aimed to study the effect of allogenic and autologous FMT on IBS symptoms, visceral sensitivity, and compositional changes in fecal and mucosa-adherent microbiota. METHODS: Seventeen patients with IBS were randomized either to receive fecal material from a healthy donor (allogenic) or to receive their own fecal material (autologous). The fecal material was administered into the cecum by whole colonoscopy after bowel cleansing. RESULTS: No significant differences were found between the allogenic and the autologous FMT regarding symptom scores. However, symptom scores of patients receiving allogenic fecal material significantly decreased after FMT compared with baseline (P = 0.02), which was not the case in the autologous group (P = 0.16). Visceral sensitivity was not affected except for a small beneficial effect on urge scores in the autologous group (P < 0.05). While both fecal and mucosa-adherent microbiota of some patients shifted to their respective donor's fecal microbiota, some patients showed no relevant microbial changes after allogenic FMT. Large compositional shifts in fecal and mucosa-adherent microbiota also occurred in the autologous group. CONCLUSIONS: This study showed that a single FMT by colonoscopy may have beneficial effects in IBS; however, the allogenic fecal material was not superior to the autologous fecal material. This suggests that bowel cleansing prior to the colonoscopy and/or processing of the fecal material as part of the FMT routine contribute to symptoms and gut microbiota composition changes in IBS.


Subject(s)
Fecal Microbiota Transplantation/methods , Feces/microbiology , Gastrointestinal Microbiome/immunology , Irritable Bowel Syndrome/therapy , Visceral Pain/therapy , Adult , Female , Humans , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/immunology , Irritable Bowel Syndrome/microbiology , Male , Middle Aged , Pain Measurement , Transplantation, Autologous/methods , Transplantation, Homologous/methods , Treatment Outcome , Visceral Pain/diagnosis , Visceral Pain/etiology
7.
Pain ; 160(1): 69-76, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30586073

ABSTRACT

Chronic visceral pain is a frequent and disabling condition. Despite high prevalence and impact, chronic visceral pain is not represented in ICD-10 in a systematic manner. Chronic secondary visceral pain is chronic pain secondary to an underlying condition originating from internal organs of the head or neck region or of the thoracic, abdominal, or pelvic regions. It can be caused by persistent inflammation, by vascular mechanisms or by mechanical factors. The pain intensity is not necessarily fully correlated with the disease process, and the chronic visceral pain may persist beyond successful treatment of the underlying cause. This article describes how a new classification of chronic secondary visceral pain is intended to facilitate the diagnostic process and to enable the collection of accurate epidemiological data. Furthermore, it is hoped that the new classification will improve the tailoring of patient-centered pain treatment of chronic secondary visceral pain and stimulate research. Chronic secondary visceral pain should be distinguished from chronic primary visceral pain states that are considered diseases in their own right.


Subject(s)
Chronic Pain , International Classification of Diseases , Organizations/standards , Visceral Pain , Chronic Pain/classification , Chronic Pain/complications , Chronic Pain/diagnosis , Humans , International Cooperation , Visceral Pain/classification , Visceral Pain/complications , Visceral Pain/diagnosis
8.
Vet J ; 242: 1-7, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30503538

ABSTRACT

In recent decades, much effort has been invested in scientific studies of objective and reliable assessment of pain in horses. Various types of pain assessment tools have been described and (partly) validated for different types of pain in horses. Currently, composite pain scales and facial expression-based pain scales seem to be the most promising tools for pain assessment in horses and numerous studies have recently been published on the use of these pain scales in horses. Therefore, this narrative review mainly focusses on these two types of pain scales and on the studies that have appeared describing these type of pain scales in horses. The extent to which these pain scales have been validated (sensitivity, specificity, inter-observer reliability etc.) and their potential use for clinical pain states is discussed. Possible future directions for new studies and their possible aid in assessing pain in hospitalised and ridden horses are presented. In this way, improved pain scoring could improve criteria used to evaluate the clinical efficacy of new analgesic drugs and techniques, potentially benefiting equine welfare.


Subject(s)
Horse Diseases/diagnosis , Pain Measurement/veterinary , Animals , Castration/veterinary , Colic/diagnosis , Colic/veterinary , Female , Horses , Male , Pain, Postoperative/diagnosis , Pain, Postoperative/veterinary , Sensitivity and Specificity , Visceral Pain/diagnosis , Visceral Pain/veterinary
9.
JCI Insight ; 3(11)2018 06 07.
Article in English | MEDLINE | ID: mdl-29875317

ABSTRACT

Functional bowel disorder patients can suffer from chronic abdominal pain, likely due to visceral hypersensitivity to mechanical stimuli. As there is only a limited understanding of the basis of chronic visceral hypersensitivity (CVH), drug-based management strategies are ill defined, vary considerably, and include NSAIDs, opioids, and even anticonvulsants. We previously reported that the 1.1 subtype of the voltage-gated sodium (NaV; NaV1.1) channel family regulates the excitability of sensory nerve fibers that transmit a mechanical pain message to the spinal cord. Herein, we investigated whether this channel subtype also underlies the abdominal pain that occurs with CVH. We demonstrate that NaV1.1 is functionally upregulated under CVH conditions and that inhibiting channel function reduces mechanical pain in 3 mechanistically distinct mouse models of chronic pain. In particular, we use a small molecule to show that selective NaV1.1 inhibition (a) decreases sodium currents in colon-innervating dorsal root ganglion neurons, (b) reduces colonic nociceptor mechanical responses, and (c) normalizes the enhanced visceromotor response to distension observed in 2 mouse models of irritable bowel syndrome. These results provide support for a relationship between NaV1.1 and chronic abdominal pain associated with functional bowel disorders.


Subject(s)
Chronic Pain/drug therapy , Colon/drug effects , Irritable Bowel Syndrome/complications , Visceral Pain/drug therapy , Voltage-Gated Sodium Channel Blockers/administration & dosage , Animals , Chronic Pain/diagnosis , Chronic Pain/etiology , Chronic Pain/pathology , Colon/innervation , Colon/pathology , Disease Models, Animal , Dose-Response Relationship, Drug , Drug Evaluation, Preclinical , Drug Stability , Ganglia, Spinal/cytology , Humans , Irritable Bowel Syndrome/chemically induced , Irritable Bowel Syndrome/pathology , Male , Maximum Tolerated Dose , Mice , NAV1.1 Voltage-Gated Sodium Channel/metabolism , Nociceptors/drug effects , Nociceptors/metabolism , Pain Measurement , Trinitrobenzenesulfonic Acid/administration & dosage , Trinitrobenzenesulfonic Acid/toxicity , Visceral Pain/diagnosis , Visceral Pain/etiology , Visceral Pain/pathology
11.
Neurogastroenterol Motil ; 30(6): e13290, 2018 06.
Article in English | MEDLINE | ID: mdl-29345401

ABSTRACT

BACKGROUND: Some consider that patients with visceral hypersensitivity may represent a separate entity within the IBS population not only from a pathophysiological but also from a clinical perspective. The aim of this prospective exploratory study was to assess whether characteristics of abdominal pain in IBS patients could be suggestive of hypersensitivity. METHODS: This prospective study included consecutive IBS patients selected by Rome III criteria. Validated scores (IBS-SSS, Bristol stool scale, HADS) were used to phenotype patients who were also asked to describe the main location of their abdominal pain on a simple image (abdomen divided into 6 zones). Progressive isobaric rectal distensions were performed to demonstrate, with the ascending method of limits, allodynia (pain threshold lower than 24 mmHg). KEY RESULTS: Fifty patients (women: 72%), 42.6 ± 15.7 years old, were included. Sub-types were IBS-D, IBS-C and IBS-M in 58%, 22% and 20% of cases, respectively. Allodynia was present in 18% of cases. Neither IBS-SSS nor intensity of pain was predictive of hypersensitivity. In hypersensitive patients, pain was more often located in one of the two iliac fossa (P = 0.02) and located outside these areas in only 11% of cases. The sensitivity and the specificity of this pain location to differentiate hyper from normosensitive patients were 0.89 and 0.59, respectively. CONCLUSIONS & INFERENCES: The location of pain is different between hyper and normosensitive IBS patients. Pain located outside one of the two iliac fossa suggests that the patient is normosensitive.


Subject(s)
Abdominal Pain/diagnosis , Hyperalgesia/diagnosis , Irritable Bowel Syndrome/diagnosis , Pain Measurement/methods , Visceral Pain/diagnosis , Abdominal Pain/physiopathology , Adult , Female , Humans , Hyperalgesia/physiopathology , Irritable Bowel Syndrome/physiopathology , Male , Middle Aged , Pain Measurement/standards , Prospective Studies , Visceral Pain/physiopathology
12.
World J Gastroenterol ; 23(16): 2928-2939, 2017 Apr 28.
Article in English | MEDLINE | ID: mdl-28522910

ABSTRACT

AIM: To observe whether there are differences in the effects of electro-acupuncture (EA) and moxibustion (Mox) in rats with visceral hypersensitivity. METHODS: EA at 1 mA and 3 mA and Mox at 43 °C and 46 °C were applied to the Shangjuxu (ST37, bilateral) acupoints in model rats with visceral hypersensitivity. Responses of wide dynamic range neurons in dorsal horns of the spinal cord were observed through the extracellular recordings. Mast cells (MC) activity in the colons of rats were assessed, and 5-hydroxytryptamine (5-HT), 5-hydroxytryptamine 3 receptor (5-HT3R) and 5-HT4R expressions in the colons were measured. RESULTS: Compared with normal control group, responses of wide dynamic range neurons in the dorsal horn of the spinal cord were increased in the EA at 1 mA and 3 mA groups (1 mA: 0.84 ± 0.74 vs 2.73 ± 0.65, P < 0.001; 3 mA: 1.91 ± 1.48 vs 6.44 ± 1.26, P < 0.001) and Mox at 43 °C and 46 °C groups (43 °C: 1.76 ± 0.81 vs 4.14 ± 1.83, P = 0.001; 46 °C: 5.19 ± 2.03 vs 7.91 ± 2.27, P = 0.01). MC degranulation rates and the expression of 5-HT, 5-HT3R and 5-HT4R in the colon of Mox 46 °C group were decreased compared with model group (MC degranulation rates: 0.47 ± 0.56 vs 0.28 ± 0.78, P < 0.001; 5-HT: 1.42 ± 0.65 vs 7.38 ± 1.12, P < 0.001; 5-HT3R: 6.62 ± 0.77 vs 2.86 ± 0.88, P < 0.001; 5-HT4R: 4.62 ± 0.65 vs 2.22 ± 0.97, P < 0.001). CONCLUSION: The analgesic effects of Mox at 46 °C are greater than those of Mox at 43 °C, EA 1 mA and EA 3 mA.


Subject(s)
Abdominal Pain/therapy , Colon/innervation , Electroacupuncture , Hyperalgesia/therapy , Irritable Bowel Syndrome/therapy , Moxibustion , Pain Management/methods , Visceral Pain/therapy , Abdominal Pain/diagnosis , Abdominal Pain/metabolism , Abdominal Pain/physiopathology , Animals , Colon/metabolism , Disease Models, Animal , Hyperalgesia/diagnosis , Hyperalgesia/metabolism , Hyperalgesia/physiopathology , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/metabolism , Irritable Bowel Syndrome/physiopathology , Male , Mast Cells/metabolism , Pain Measurement , Posterior Horn Cells/metabolism , Rats, Sprague-Dawley , Receptors, Serotonin, 5-HT3/metabolism , Receptors, Serotonin, 5-HT4/metabolism , Serotonin/metabolism , Temperature , Visceral Pain/diagnosis , Visceral Pain/metabolism , Visceral Pain/physiopathology
13.
Pancreas ; 46(2): 170-176, 2017 02.
Article in English | MEDLINE | ID: mdl-28060186

ABSTRACT

OBJECTIVES: Many patients with painful chronic pancreatitis (CP) have insufficient effect of treatment, and the prevalence of adverse effects is high. Consequently, alternatives to conventional management are needed. We aimed to study the effect of acupuncture in painful CP. METHODS: This was a prospective, single-blinded, randomized crossover trial. Fifteen patients with CP were assigned to a session of acupuncture followed by sham stimulation or vice versa. Patients rated clinical pain scores daily on a 0 to 10 visual analogue scale (VAS) and completed the Patient Global Impression of Change. For mechanistic linkage, resting state electroencephalograms were recorded and quantified by spectral power analysis to explore effects on central pain processing. RESULTS: Acupuncture, compared with sham stimulation, caused more pain relief (2.0 ± 1.5 VAS vs 0.7 ± 0.8 VAS; P = 0.009). The effect, however, was short, and after 1-week follow-up, there was no difference in clinical pain scores between groups (P = 1.0) or the rating of Patient Global Impression of Change (P = 0.8). Electroencephalogram spectral power distributions between sham and acupuncture were comparable between groups (all P > 0.6). CONCLUSIONS: The study presents proof-of-concept for the analgesic effect of acupuncture in pancreatic pain. Although the effect was short lasting, the framework may be used to conceptualize future trials of acupuncture in visceral pain.


Subject(s)
Acupuncture Therapy/methods , Pain Measurement/methods , Pancreatitis, Chronic/complications , Visceral Pain/therapy , Adult , Aged , Cross-Over Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Single-Blind Method , Treatment Outcome , Visceral Pain/diagnosis , Visceral Pain/etiology
14.
Aliment Pharmacol Ther ; 45(1): 100-114, 2017 01.
Article in English | MEDLINE | ID: mdl-27862119

ABSTRACT

BACKGROUND: Neural-immune-endocrine network mechanism has attracted increased attention in diarrhoea-predominant irritable bowel syndrome (IBS-D). Pre-clinical evidence indicates that nerve growth factor (NGF) mediates visceral hypersensitivity and gut barrier dysfunction, via interactions with mast cells and sensory nerve fibres. AIM: To explore the role of nerve growth factor, as well as mast cell-nerve growth factor-nerve interaction in IBS-D pathophysiology. METHODS: In this cross-sectional study, IBS-D patients and healthy controls first underwent clinical and psychological assessments. Visceral sensitivity to rectal distension was tested. As gut barrier function markers, serum diamine oxidase and d-lactate were detected. Rectosigmoid biopsies were taken for the analyses of nerve growth factor expression, mast cell count and activation, and sensory nerve fibres expressing transient receptor potential vanilloid 1 and calcitonin gene-related peptide. Correlations between these parameters were examined in patients. RESULTS: Thirty-eight IBS-D patients (28 males, 10 females; average age 30.2 years) and 20 healthy controls (12 males, 8 females; average age 26.8 years) participated in the study. The patients presented increased psychological symptoms, visceral hypersensitivity and impaired gut barrier function. NGF gene expression, mast cell count and sensory nerve fibres were significantly increased in the patients (P < 0.05). In correlation analysis, NGF expression was positively correlated with the disease severity, anxiety and serum diamine oxidase; visceral sensitivity thresholds were negatively associated with NGF expression (Bonferroni corrected P < 0.0029). CONCLUSIONS: Elevated mucosal NGF may interact with mast cells and sensory nerve fibres, contributing to visceral hypersensitivity and impaired gut barrier function in IBS-D.


Subject(s)
Diarrhea/blood , Gastric Mucosa/metabolism , Intestinal Mucosa/metabolism , Irritable Bowel Syndrome/blood , Nerve Growth Factor/blood , Visceral Pain/blood , Adult , Cross-Sectional Studies , Diarrhea/diagnosis , Diarrhea/physiopathology , Female , Gastric Mucosa/pathology , Gastrointestinal Absorption/physiology , Gene Expression , Humans , Intestinal Mucosa/pathology , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/physiopathology , Male , Middle Aged , Pain Measurement/methods , Visceral Pain/diagnosis , Visceral Pain/physiopathology , Young Adult
15.
In. Yera Nadal, Jorge Luis; Garrido Suárez, Bárbara Beatriz; Santos Anzorandia, Carlos Miguel; Martínez Suárez, Juan Eduardo. Temas de medicina del dolor. La Habana, ECIMED, 2017. , tab.
Monography in Spanish | CUMED | ID: cum-67005
16.
Vet J ; 216: 175-7, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27687948

ABSTRACT

This study presents the validation of two recently described pain scales, the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP), in horses with acute colic. A follow-up cohort study of 46 adult horses (n = 23 with acute colic; n = 23 healthy control horses) was performed for validation and refinement of the constructed scales. Both pain scales showed statistically significant differences between horses with colic and healthy control horses, and between horses with colic that could be treated conservatively and those that required surgical treatment or were euthanased. Sensitivity and specificity were good for both EQUUS-COMPASS (87% and 71%, respectively) and EQUUS-FAP (77% and 100%, respectively) and were not substantially influenced by applying weighting factors to the individual parameters.


Subject(s)
Acute Pain/veterinary , Colic/veterinary , Horse Diseases/diagnosis , Pain Measurement/veterinary , Visceral Pain/veterinary , Acute Pain/diagnosis , Animals , Colic/diagnosis , Female , Follow-Up Studies , Horses , Pain Measurement/methods , Sensitivity and Specificity , Visceral Pain/diagnosis
17.
Neurogastroenterol Motil ; 28(11): 1613-1618, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27781369

ABSTRACT

Ion channels are expressed throughout the gastrointestinal system and regulate nearly every aspect of digestion, including fluid secretion and absorption, motility, and visceral sensitivity. It is therefore not surprising that in the setting of functional bowel disorders, such as irritable bowel syndrome (IBS), ion channels are often altered in terms of expression level and function and are a target of pharmacological intervention. This is particularly true of their role in driving abdominal pain through visceral hypersensitivity (VH), which is the main reason IBS patients seek medical care. In the study by Scanzi et al., in the current issue of this journal, they provide evidence that the T-type voltage-gated calcium channel (Cav ) Cav 3.2 is upregulated in human IBS patients, and is necessary for the induction of an IBS-like disease state in mice. In this mini-review, we will discuss the contribution of specific ion channels to VH in IBS, both in human patients and rodent models. We will also discuss how Cav 3.2 may play a role as an integrator of multiple environmental stimuli contributing toward VH.


Subject(s)
Calcium Channels, T-Type/physiology , Irritable Bowel Syndrome/physiopathology , TRPV Cation Channels/physiology , Visceral Pain/physiopathology , Animals , Humans , Ion Channels/physiology , Irritable Bowel Syndrome/diagnosis , Pain Threshold/physiology , Visceral Pain/diagnosis
18.
Neurogastroenterol Motil ; 28(7): 1094-103, 2016 07.
Article in English | MEDLINE | ID: mdl-26993039

ABSTRACT

BACKGROUND: Irritable bowel syndrome (IBS) is a heterogeneous condition with a number of pathophysiological mechanisms that appear to contribute to symptom chronicity. One of these is altered pain sensitivity. METHODS: Women between ages 18-45 were recruited the community. Of those enrolled, 56 had IBS and 36 were healthy control (HC) women. Participants completed questionnaires, kept a 4-week symptom diary and had a 12-h Holter placed to assess nighttime heart rate variability including high frequency power (HF), low frequency power (LF), and total power (TP). At mid-follicular phase approximately 80% of women completed a thermal pain sensitivity test with conditioned pain modulation and visceral pain sensitivity using a water load symptom provocation (WLSP) test. KEY RESULTS: As expected, daily abdominal pain was significantly higher in the IBS compared to HC group. There were no differences between the bowel pattern subgroups (IBS-diarrhea [IBS-D], IBS-constipation plus mixed [IBS-CM]). Thermal pain sensitivity did not differ between the IBS and the HC groups, but was significantly higher in the IBS-CM group than the IBS-D group. In the WLSP test, the IBS group experienced significantly more symptom distress than HCs and the IBS-CM group was higher than the IBS-D group. Heart rate variability indicators did not differ between the groups or IBS subgroups. Daily abdominal pain was positively correlated with LF and TP in the IBS group. CONCLUSIONS & INFERENCES: Despite similar levels of abdominal pain in IBS, the IBS-CM group demonstrated greater sensitivity to both thermal and visceral testing procedures.


Subject(s)
Abdominal Pain/physiopathology , Heart Rate/physiology , Irritable Bowel Syndrome/physiopathology , Pain Measurement/methods , Pain Threshold/physiology , Visceral Pain/physiopathology , Abdominal Pain/diagnosis , Abdominal Pain/psychology , Adult , Female , Hot Temperature/adverse effects , Humans , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/psychology , Pain Threshold/psychology , Visceral Pain/diagnosis , Visceral Pain/psychology , Young Adult
19.
BMC Musculoskelet Disord ; 17: 58, 2016 Feb 04.
Article in English | MEDLINE | ID: mdl-26846674

ABSTRACT

BACKGROUND: Joint hypermobility syndrome describes a disorder in which musculoskeletal pain occurs in a generalized joint hypermobility substrate. The clinical picture comprises variable manifestations which involve mainly but not exclusively the musculoskeletal system, and evolve over the person's lifetime. CASE PRESENTATION: Describing the case of a 20-year-old female with generalized arthro-myalgias, persistent fatigue and troublesome visceral pain, we illustrate how a frequently ignored clinical sign such as joint hypermobility can be the keystone to clarify different simultaneous symptoms. All of the patient's physical complaints had been investigated separately during her previous medical examinations, and several tests repeatedly gave negative results. The patient received different diagnoses that describe only part of her problems, such as irritable bowel syndrome for visceral pain, fibromyalgia for arthralgias or depression for fatigue. These approaches gave rise to pharmacological or physical treatments which did not improve her quality of life in any way and in some instances worsened the situation. Pronounced joint hypermobility which led the patient to flex her joints excessively, causing subluxations in several districts, was the only sign overlooked. CONCLUSION: Exploring the patient's articular features in her clinical context led us to diagnose joint hypermobility syndrome, a complex and often ignored condition. The case highlights the utility of a multidisciplinary approach and coordinated interventions to define and manage this clinical entity.


Subject(s)
Arthralgia/diagnosis , Fatigue/diagnosis , Joint Instability/congenital , Paresthesia/diagnosis , Visceral Pain/diagnosis , Arthralgia/complications , Fatigue/complications , Female , Humans , Joint Instability/complications , Joint Instability/diagnosis , Paresthesia/complications , Visceral Pain/complications , Young Adult
20.
Curr Rheumatol Rev ; 12(1): 13-26, 2016.
Article in English | MEDLINE | ID: mdl-26717952

ABSTRACT

Symptoms of irritable bowel syndrome (IBS) are common in population studies including chronic abdominal pain associated with altered bowel habits. Patients often have associated gastrointestinal and somatic symptoms suggesting a possible common contributing mechanism, but the heterogeneous symptom patterns of individual patients make generalizations difficult. The pathophysiology of IBS is incompletely understood but includes disturbances of the brain-gut axis. Central mechanisms are: the psychosocial history and environment, dysfunctional brain processing of peripheral signals attributed to the intestine including the enteric nervous system, the microbiome and the innate and adaptive immune system. As a result there is visceral hypersensitivity and disturbed intestinal secretory and motor activity. Some mechanisms of visceral pain hypersensitivity may overlap with other pain syndromes including fibromyalgia (FMS). Central Sensitization (CS) would offer a way to conceptualize an integration of life experience and psychologic response into a biopsychosocial framework of pathophysiology, diagnosis and treatment of IBS. Corticotropin-releasing factor, a principle regulator in the stress and pain response may contribute to a neuroendocrine mechanism for the brain-gut interaction. The positive diagnostic approach to IBS symptoms to avoid excess testing and enhance the patient-provider therapeutic relationship requires the recognition of the "cluster" of IBS symptoms while identifying "alarm" symptoms requiring specific attention. The severity of the symptoms and other individual psychosocial factors characterize patients who seek medical care. The presence of significant psychosocial comorbidities adds to the complexity of management which often requires a multidisciplinary approach. Several treatment options exist but no single method is effective for all the symptoms of IBS. The therapeutic benefit of the well-executed physician-patient relationship is considered essential to success in managing IBS symptoms over the long term.


Subject(s)
Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/therapy , Pain Management/methods , Abdominal Pain/diagnosis , Abdominal Pain/epidemiology , Abdominal Pain/therapy , Humans , Irritable Bowel Syndrome/epidemiology , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Stress, Psychological/therapy , Visceral Pain/diagnosis , Visceral Pain/epidemiology , Visceral Pain/therapy
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