A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction

Keefer, Laurie; Ballou, Sarah; Drossman, Douglas A.; Ringström, Gisela; Elsenbruch, Sigrid; Ljótsson, Brjánn

doi:10.1053/j.gastro.2021.09.015

Cited by 77 publications

(81 citation statements)

References 113 publications

(131 reference statements)

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“…Especially in these patient groups is it likely that treatment expectations dynamically change over time, and are influenced by treatment experiences, including prior treatment successes and failures. At the same time, patients with disorders of gut-brain interactions benefit from psychological treatment approaches ( 39 ), which could be further informed by knowledge derived from placebo research to elucidate predictors of treatment satisfaction ( 40 ). While our comparatively short experimental paradigm captured the experience of pain relief, we did not model fluctuating symptoms or analyze dynamic changes in pain.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…BGBT encompasses several techniques including disease self-management, cognitive behavior therapy (CBT), gut-directed hypnotherapy, mindfulness-based stress reduction, and psychodynamic interpersonal psychotherapy. 45…”

Section: Psychother Apy and B Ehavior Al Modific Ationmentioning

confidence: 99%

Pain in irritable bowel syndrome: Does anything really help?

BouSaba

Sannaa

Camilleri

2021

Neurogastroenterology Motil

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Pain relief remains a significant challenge in the management of irritable bowel syndrome (IBS): "Does anything really help relieve the pain in patients with IBS?".Interventions aimed at pain relief in patients with IBS include diet, probiotics or antibiotics, antidepressants, antispasmodics, and drugs targeting specific gastrointestinal receptors such as opioid or histamine receptors. In the systematic review and metaanalysis published in this journal, Lambarth et al. examined the literature on the role of oral and parenteral anti-neuropathic agents in the management of pain in patients with IBS. This review article appraises their assessment of the efficacy of the antineuropathic agents amitriptyline, pregabalin, gabapentin, and duloxetine in the relief of abdominal pain or discomfort, and impact on overall IBS severity and quality of life. This commentary provides an update of current evidence on the efficacy of the dietary and pharmacological treatments that are available or in development, as well psychological and cognitive behavioral therapy for pain in IBS. Advances in recent years augur well for efficacious treatments that may expand the therapeutic arsenal for pain in IBS.

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“…8,31 Reassurance and expectation-setting are particularly important for these patients. 36 Explaining the processes of symptom generation in patient-friendly language will not only help direct self-care and treatment adherence but can itself be considered an intervention. As first suggested in the 1950s by the psychoanalyst Michael Balint, "By far the most frequently used drug in general practice is the doctor himself".…”

Section: Patient-clinician Communicationmentioning

confidence: 99%

“…Symptom-specific psychotherapies can target visceral hypersensitivity and centrally mediated hyperalgesia (increased sensitivity to pain signals), as well as avoidance behaviours, hypervigilance and pain catastrophizing. 24,36 Applying these therapies depends on first gaining insight into the patient symptom experience because this often aligns poorly with the clinician's initial assessment. Interpretation of symptoms as harmful or threatening can negatively impact health-related quality of life (HRQOL) just as much as symptom severity and frequency.…”

Section: Gut-brain Behavioural Therapies and Neuromodulatorsmentioning

confidence: 99%

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Hungin

Scarpignato

Keefer

et al. 2022

Aliment Pharmacol Ther

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Summary Background Despite widespread adoption of potent acid suppression treatment with proton pump inhibitors (PPI) for reflux‐like symptoms, persistent symptoms are commonly reported in primary care and community studies. Aims This multidisciplinary review critically evaluates how the management of reflux‐like symptoms could better reflect their multifactorial pathophysiology. Methods A panel of experts (from general practice, gastroenterology and gastropsychology) attended a series of workshops to review current management and propose a framework for the provision of more individualised care. Results It was agreed that the perceptual (as well as the physiological) causes of reflux‐like symptoms should be considered at the start of management, not as a last resort when all else has failed. A short course of PPI is a pragmatic approach to address reflux‐like symptoms, but equally important is counselling about the gut‐brain axis and provision of symptom‐specific behavioural interventions for those who show signs of somatisation, hypervigilance or co‐existing disorders of gut‐brain interaction. Other low‐harm interventions such as lifestyle and dietary advice, should also be better integrated into care at an early stage. Multidisciplinary care management programmes (including dietary, weight loss, exercise and behavioural intervention) should be developed to promote greater self‐management and take advantage of the general shift toward the use of remotely accessed health care resources. Conclusions Management of reflux‐like symptoms should be adapted to reflect the advances in knowledge about the multifactorial aetiology of these symptoms, addressing both acid‐related and behavioural components early in management. The time has come to treat the patient, not the “disease”.

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A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction

Cited by 77 publications

References 113 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

Pain in irritable bowel syndrome: Does anything really help?

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

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