Journal
PAIN
Volume 148, Issue 1, Pages 49-58Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.pain.2009.10.005
Keywords
Pain; Hypersensitivity; IBS; Irritable bowel syndrome; Diffuse noxious inhibitory controls; DNIC; Counterirritation; Pain modulation; Analgesia; Psychological symptoms
Categories
Funding
- Fonds de recherche en sante du Quebec
- Canadian Institutes of Health Research
- Fondation chiropratique du Quebec
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The mechanisms of chronic pain in irritable bowel syndrome (IBS) have been widely investigated but remain unclear. The present study investigated the relation between visceral hypersensitivity, cutaneous thermal sensitivity, and central pain mechanisms. Rectal sensitivity was assessed with a barostat, and forearm and calf sensitivity with a contact thermode. Central mechanisms were assessed by counterirritation using sustained cold-pain to the hand and painful electric shocks to the ankle. Psychological symptoms were also assessed, using questionnaires. Female volunteers with diarrhea-predominant IBS (n = 27) and healthy controls (n = 25) participated in the study. IBS patients had lower rectal and calf pain thresholds compared to controls (p's < 0.05). IBS patients also reported more pain than controls for rectal distensions, and heat pain on the calf and forearm (all p's < 0.001). Cold-pain inhibited shock-pain in controls but not IBS patients (controls: -13.5 +/- 5.3 vs IBS: + 1.9 +/- 10.5; p < 0.01). In addition, visceral hypersensitivity was significantly correlated to cutaneous thermal hypersensitivity and pain inhibition deficits, although effects were only weak and moderate, respectively. Furthermore, covariance analyses indicated that psychological factors accounted for group differences in visceral hypersensitivity and pain inhibition deficits. In conclusion, this study confirms the relation between altered pain inhibition processes and widespread hypersensitivity in IBS. The present results also suggests that psychological symptoms and altered pain processing in IBS patients may reflect at least in part, common underlying mechanisms. (C) 2009 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.
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