Visceral Pain: From Bench to Bedside

Elsenbruch, Sigrid; Benson, Sven

doi:10.1016/b978-0-12-805408-6.00019-1

Cited by 2 publications

(3 citation statements)

References 131 publications

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“…While placebo research in pain has a strong tradition, owing to placebo analgesia as one prominent example of expectancy effects on patient-reported outcomes, the large area of visceral pain has played a comparatively minor role in this translational research field ( 3 ). Visceral pain is of high clinical relevance, especially in disorders of gut-brain interactions like the irritable bowel syndrome, but also in inflammatory bowel disease (IBD) and a range of other clinical conditions in gastroenterology, gynecology, urology, and psychosomatic medicine ( 4 , 5 ). Since the notable clinical work by Kaptchuk and colleagues demonstrating the therapeutic potential of placebo interventions in patients with IBS ( 6 , 7 ), clinical research on visceral pain modulation and impact of expectancy effects on treatment responses in clinical trials in the gastrointestinal field continues to thrive ( 3 , 8 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

Positive Treatment Expectations Shape Perceived Medication Efficacy in a Translational Placebo Paradigm for the Gut-Brain Axis

et al. 2022

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Placebo research has established the pivotal role of treatment expectations in shaping symptom experience and patient-reported treatment outcomes. Perceived treatment efficacy constitutes a relevant yet understudied aspect, especially in the context of the gut-brain axis with visceral pain as key symptom. Using a clinically relevant experimental model of visceral pain, we elucidated effects of pre-treatment expectations on post-treatment perceived treatment efficacy as an indicator of treatment satisfaction in a translational placebo intervention. We implemented positive suggestions regarding intravenous treatment with a spasmolytic drug (in reality saline), herein applied in combination with two series of individually calibrated rectal distensions in healthy volunteers. The first series used distension pressures inducing pain (pain phase). In the second series, pressures were surreptitiously reduced, modeling pain relief (pain relief phase). Using visual analog scales (VAS), expected and perceived treatment efficacy were assessed, along with perceived pain intensity. Manipulation checks supported that the induction of positive pre-treatment expectations and the modeling of pain relief were successful. Generalized Linear Models (GLM) were implemented to assess the role of inter-individual variability in positive pre-treatment expectations in perceived treatment efficacy and pain perception. GLM indicated no association between pre-treatment expectations and perceived treatment efficacy or perceived pain for the pain phase. For the relief phase, pre-treatment expectations (p = 0.024) as well as efficacy ratings assessed after the preceding pain phase (p < 0.001) were significantly associated with treatment efficacy assessed after the relief phase, together explaining 54% of the variance in perceived treatment efficacy. The association between pre-treatment expectations and perceived pain approached significance (p = 0.057) in the relief phase. Our data from an experimental translational placebo intervention in visceral pain support that reported post-treatment medication efficacy is shaped by pre-treatment expectations. The observation that individuals with higher positive expectations reported less pain and higher treatment satisfaction after pain relief may provide first evidence that perceived symptom improvement may facilitate treatment satisfaction. The immediate experience of symptoms within a given psychosocial treatment context may dynamically change perceptions about treatment, with implications for treatment satisfaction, compliance and adherence of patients with conditions of the gut-brain axis.

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Section: Introductionmentioning

confidence: 99%

Positive Treatment Expectations Shape Perceived Medication Efficacy in a Translational Placebo Paradigm for the Gut-Brain Axis

et al. 2022

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“…Visceral pain, i.e., pain arising from the inner organs, is in various aspects different to somatic pain. Painful visceral stimuli are conveyed via a distinct innervation, and visceral pain is perceived as more diffuse, unpleasant, and burdening when compared to somatic pain [ 75 ]. The pressure-controlled rectal distension model offers a valid, clinically relevant method to experimentally assess visceral pain thresholds and pain ratings in patients with functional and inflammatory bowel conditions and in nonclinical cohorts.…”

Section: Inflammation and Painmentioning

confidence: 99%

“…Learning to predict pain and aversive symptoms is an important prerequisite to avoid future harm. However, maladaptive pain-related learning and memory processes may also contribute to the chronification of pain [ 75 ]. Against the background that inflammation can interfere with learning and memory processes, two studies have addressed LPS effects on pain-related learning and memory in the visceral pain model [ 22 , 109 ].…”

Section: Mood and Cognition Interact With Inflammation And Painmentioning

confidence: 99%

How Can Experimental Endotoxemia Contribute to Our Understanding of Pain? A Narrative Review

Benson,

Karshikoff

2023

Neuroimmunomodulation

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Background: The immune system and the central nervous system exchange information continuously. This communication is a prerequisite for adaptive responses to physiological and psychological stressors. While the implicate relationship between inflammation and pain is increasingly recognized in clinical cohorts, the underlying mechanisms and the possibilities for pharmacological and psychological approaches aimed at neuro-immune communication in pain are not fully understood yet. This calls for preclinical models which build a bridge from clinical research to laboratory research. Summary: Experimental models of systemic inflammation (experimental endotoxemia) in humans have been increasingly recognized as an approach to study the direct and causal effects of inflammation on pain perception. This narrative review provides an overview of what experimental endotoxemia studies on pain have been able to clarify so far. We report that experimental endotoxemia results in a reproducible increase in pain sensitivity, particularly for pressure and visceral pain (deep pain), which is reflected in responses of brain areas involved in pain processing. Increased levels of blood inflammatory cytokines are required for this effect, but cytokine levels do not always predict pain intensity. We address sex-dependent differences in immunological responses to endotoxin, and discuss why these differences do not necessarily translate to differences in behavioral measures. We summarize psychological and cognitive factors that may moderate pain sensitization driven by immune activation. Key messages: Together, studying the immune-driven changes in pain during endotoxemia offers a deeper mechanistic understanding of the role of inflammation in chronic pain. Experimental endotoxemia models can specifically help to tease out inflammatory mechanisms underlying individual differences, vulnerabilities, and comorbid psychological problems in pain syndromes. The model offers the opportunity to test the efficacy of interventions, increasing their translational applicability for personalized medical approaches.

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Visceral Pain: From Bench to Bedside

Cited by 2 publications

References 131 publications

Positive Treatment Expectations Shape Perceived Medication Efficacy in a Translational Placebo Paradigm for the Gut-Brain Axis

Positive Treatment Expectations Shape Perceived Medication Efficacy in a Translational Placebo Paradigm for the Gut-Brain Axis

How Can Experimental Endotoxemia Contribute to Our Understanding of Pain? A Narrative Review

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