Neural circuitry of abdominal pain‐related fear learning and reinstatement in irritable bowel syndrome

Icenhour, Adriane; Langhorst, Jost; Benson, Sven; Schlamann, Marc; Hampel, S.; Engler, Harald; Forsting, Michael; Elsenbruch, Sigrid

doi:10.1111/nmo.12489

Cited by 101 publications

(117 citation statements)

References 65 publications

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“…This mechanism may also perpetuate food avoidance in atypical cases of AN that lack fear of fatness and is consistent with a recent fMRI study demonstrating impaired abdominal pain-related fear conditioning and fear extinction in individuals with irritable bowel syndrome [88].…”

Section: Accepted Manuscriptsupporting

confidence: 57%

Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning

Guarda¹,

Schreyer²,

Boersma³

et al. 2015

Physiology & Behavior

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Section: Accepted Manuscriptsupporting

confidence: 57%

Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning

Guarda¹,

Schreyer²,

Boersma³

et al. 2015

Physiology & Behavior

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“…Analogous to classicallyconditioned taste aversion in rotation-chair induced motion sickness, pairing neutral stimuli (such as, visual cues) with visceral pain results in a learned emotional response to formerly neutral cues. [162][163][164] Intriguingly, this effect of emotional learning through association with aversive visceral cues seems to be disturbed in patients with IBS, in part owing to changes in the corticotropin-releasing factor system. 165 Whether and how classical conditioning contributes to hyperalgesia and pain chronicity is a subject of ongoing work, and this might involve perceptual discrimination.…”

Section: Visceral Painmentioning

confidence: 96%

Placebo effects and their determinants in gastrointestinal disorders

Elsenbruch

Enck²

2015

Nat Rev Gastroenterol Hepatol

150

112

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Placebo effects in clinical trials have sparked an interest in the placebo phenomenon, both in randomized controlled trials (RCTs) and in experimental gastroenterology. RCTs have demonstrated similar short-term and long-term placebo response rates in gastrointestinal compared to other medical diagnoses. Most mediators and moderators of placebo effects in gastrointestinal diseases are also of similar type and size to other medical diagnoses and not specific for gastrointestinal diagnoses. Other characteristics such as an increase in the placebo response over time and the placebo-enhancing effects of unbalanced randomization were not seen, at least in IBS. Experimental placebo and nocebo studies underscore the 'power' of expectancies and conditioning processes in shaping gastrointestinal symptoms not only at the level of self-reports, but also within the brain and along the brain-gut axis. Brain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias. These findings raise hope that sophisticated trials and experiments designed to boost positive expectations and minimize negative expectations could pave the way for a practical and ethically sound use of placebo knowledge in daily practice. Rather than focusing on a 'personalized' choice of drugs based on biomarkers or genes, it might be the doctor-patient communication that needs to be tailored.

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“…Despite the absence of perceptual hypersensitivity to rectal distension, these patients exhibit chronic gastrointestinal (GI) symptoms and demonstrate alterations in brain responses to experimental pain stimuli (Elsenbruch et al, 2010a, Elsenbruch et al, 2010b, Icenhour et al, 2015). Even though there is evidence suggesting differences between hypersensitive and normosensitive patients in response to painful stimuli (Larsson et al, 2012, Van Oudenhove et al, 2010), the relation between altered FC of brain networks and visceral sensitivity remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Brain functional connectivity is associated with visceral sensitivity in women with Irritable Bowel Syndrome

Icenhour

Witt

Elsenbruch

et al. 2017

NeuroImage: Clinical

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Increased perception of visceral stimuli is a key feature of Irritable Bowel Syndrome (IBS). While altered resting-state functional connectivity (rsFC) has been also reported in IBS, the relationship between visceral hypersensitivity and aberrant rsFC is unknown. We therefore assessed rsFC within the salience, sensorimotor and default mode networks in patients with and without visceral hypersensitivity and in healthy controls (HCs).An exploratory resting-state functional magnetic resonance imaging study was performed in 41 women with IBS and 20 HCs. Group independent component analysis was used to derive intrinsic brain networks. Rectal thresholds were determined and patients were subdivided into groups with increased (hypersensitive IBS, N = 21) or normal (normosensitive IBS, N = 20) visceral sensitivity. Between-group comparisons of rsFC were carried-out using region-of-interest analyses and peak rsFC values were extracted for correlational analyses.Relative to normosensitive IBS, hypersensitive patients showed increased positive rsFC of pregenual anterior cingulate cortex and thalamus within the salience network and of posterior insula within the sensorimotor network. When compared to both hypersensitive IBS and HCs, normosensitive IBS showed decreased positive rsFC of amygdala and decreased negative rsFC in dorsal anterior insula within the DMN. DMN and sensorimotor network rsFC were associated with rectal perception thresholds, and rsFC in posterior insula was correlated with reported symptom severity in IBS.Our exploratory findings suggest that visceral sensitivity in IBS is related to changes in FC within resting-state networks associated with interoception, salience and sensory processing. These alterations may play an important role in hypervigilance and hyperalgesia in IBS.

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Neural circuitry of abdominal pain‐related fear learning and reinstatement in irritable bowel syndrome

Cited by 101 publications

References 65 publications

Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning

Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning

Placebo effects and their determinants in gastrointestinal disorders

Brain functional connectivity is associated with visceral sensitivity in women with Irritable Bowel Syndrome

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