Journal
NEUROGASTROENTEROLOGY AND MOTILITY
Volume 23, Issue 7, Pages E261-E270Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1365-2982.2011.01734.x
Keywords
chemosensitivity; functional dyspepsia; sensitization; TRPV1
Funding
- Singapore National Medical Research Council [NMRC/1120/2007]
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Background Sensory sensitization is one of the main pathophysiological hypotheses in functional gastrointestinal disorders (FGIDs). As sensitization may affect various sensory modalities, we aimed to develop a reproducible gastric pain model utilizing polymodal pathways for use in functional and other pain disorders. Methods In this double-blind, cross-over study 42 healthy subjects swallowed one capsule containing either capsaicin 0.5 mg or nocebo every 15 min until moderate pain (intensity > 30 on 100 mm visual analogue scale) was attained for at least 5 min. Pain was rated every minute. Capsaicin titration was repeated thrice for reliability calculation. Key Results Moderate pain in the upper abdomen was successfully achieved in 38 of 42 subjects (90%) with capsaicin titration and in one of 42 (2%) with nocebo. The median dosage required to induce moderate pain for at least 5 min was two capsules (interquartile range 1-3) and the median gastric pain intensity was 47 (41-53). The median duration of moderate pain was 8 min (5-12). Moderate pain was successfully reproduced with capsaicin in all subjects on study days 2 and 3, with an excellent Cronbach reliability coefficient of > 0.8. Conclusions & Inferences Standardized gastric pain can be conveniently achieved in a majority of healthy subjects using a simple oral capsaicin titration, with minimal adverse events. The between-test reproducibility is high and nocebo responses are negligible. This technique stimulating a multimodal physiological pathway will be useful in the investigation of sensory changes in FGIDs, including functional dyspepsia.
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