Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective

Abstract

Chronic diffuse pain disorders, such as fibromyalgia, and functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, place substantial burden on those affected and on the medical system. Despite their sizable impact, their pathophysiology is poorly understood. In contrast to an approach that focuses on the correlation between heart rate variability (HRV) and a specific organ or symptom, we propose that a bio-evolutionary threat-related autonomic response—as outlined in the Polyvagal Theory—may serve as a plausible explanation of how HRV, particularly respiratory sinus arrhythmia (RSA), would index the pathophysiology of these disorders. Evidence comes from: (1) the well-documented atypical autonomic regulation of the heart common to fibromyalgia and irritable bowel syndrome reflected in dampened RSA, (2) the neural architecture that integrates the heart, pain pathways, and the gastrointestinal tract, (3) the common physical co-morbidities shared by chronic diffuse pain and FGIDs, many of which are functionally regulated by the autonomic nervous system, (4) the elevated risk of chronic diffuse pain and FGIDs following traumatic stress or abuse, (5) and the elevated risk of chronic diffuse pain and FGIDs in individuals with anxiety and panic disorders. This novel conceptualization points to a pathogenesis rooted in changes to brain-body autonomic feedback loops in response to evolutionarily-salient threat cues, providing an integrated biopsychosocial model of chronic diffuse pain and FGIDs and suggesting new, non-pharmacological treatment strategies.

Exercise activates vagal induction of dopamine and attenuates systemic inflammation

“…Our results concur with previous studies showing that moderate bouts of swimming minimize metabolic stress (Grimonprez et al, 2015; Krahl et al, 2004). However, physiological stress during swimming can cause vagal activation as previously reported in the polyvagal theory (Bassi et al, 2018; Kolacz and Porges, 2018; Porges, 1992). Our results show that one bout of moderate-intensity aerobic swimming induced different effects than that reported in intense or long-term exercise.…”

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

“…Some of these effects, such as hypervigilance and sensitized threat responses, are indicative of the adaptive calibration for survival in dangerous environments. Other outcomes such as chronic abdominal pain do not have obvious adaptive value and, we argue, are caused by disruption of the feedback loops necessary for optimal function (see also Kolacz & Porges, ). We describe here several potential mechanisms for promoting and maintaining ANS threat activation.…”

“…VVC activity is dampened and reactions to stressors are atypical in women with a maltreatment history, even when they do not meet the criteria for PTSD, and is related to higher rates of psychological distress (Dale et al, ). Moreover, trauma survivors are at increased risk of developing somatic problems such as chronic widespread pain and GI problems, which are consistent with shifts in autonomic state regulation (Kolacz & Porges, ).…”

Targeting the Autonomic Nervous System Balance in Patients with Chronic Low Back Pain using Transcranial Alternating Current Stimulation: A Randomized, Crossover, Double-Blind, Placebo-Controlled Pilot Study

“…RSA adapts quickly due to both internal and external perturbations (20), therefore a treatment to create a lasting effect needs to be consistent, such as structured resonance breathing training daily (61).…”

“…In the case of chronic pain, this process may trigger hyperarousal of the sympathetic nervous system (17). Based on the Polyvagal theory (18,19), an evolutionary neurophysiological model of the autonomic response to safety and threat, chronic maintenance of threat responses can lead to a compromised functional state (20). These chronic systemic functional problems are reflected in the regulation of the heart by the most rapidly responsive component of the nervous system, the ventral vagal complex, as measured by RSA (19).…”