Does pain modality play a role in the interruptive function of acute visceral compared with somatic pain?

Abstract

Acute pain captures attentional resources and interferes with ongoing cognitive processes, including memory encoding. Despite broad clinical implications of this interruptive function of pain for the pathophysiology and treatment of chronic pain conditions, existing knowledge exclusively relies on studies using somatic pain models. Visceral pain is highly prevalent and seems to be more salient and threatening, suggesting that the interruptive function of pain may be higher in acute visceral compared with somatic pain. Implementing rectal distensions as a clinically relevant experimental model of visceral pain along with thermal cutaneous pain for the somatic modality, we herein examined the impact of pain modality on visual processing and memory performance in a visual encoding and recognition task and explored the modulatory role of pain-related fear and expectation in 30 healthy participants. Despite careful and dynamically adjusted matching of stimulus intensities to perceived pain unpleasantness over the course of trials, we observed greater impairment of cognition performance for the visceral modality with a medium effect size. Task performance was not modulated by expectations or by pain-related fear. Hence, even at matched unpleasantness levels, acute visceral pain is capable of interfering with memory encoding, and this impact seems to be relatively independent of pain-related cognitions or emotions, at least in healthy individuals. These results likely underestimate the detrimental effect of chronic pain on cognitive performance, which may be particularly pronounced in acute and chronic visceral pain.

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

“…It is also conceivable that the experience of pain relief engages cognitive mechanisms integrating predictions with perceptions ( 33 ), which may interact with psychological states and traits relevant to gastrointestinal symptoms ( 34 ). The unique perceptual characteristics and emotional properties of aversive visceral signals, especially their diffuse and threatening nature ( 35 – 38 ), call for dedicated mechanistic work in the visceral domain, to clarify if our findings in a small sample of healthy individuals are replicable and generalize to patient populations. Indeed, visceral pain-related expectancy effects are of particular relevance to the treatment of patients with disturbed gut-brain interactions like IBS who commonly experience fluctuating symptoms, and rarely achieve immediate symptom relief with available treatment options.…”

Do we perceive sensations inside and outside of our body differently? Perceptual, emotional, and behavioral differences between visceral and somatic sensation, discomfort, and pain

“…This finding is novel, as the majority of experimental research comparing the two modalities focuses on pain. Visceral stimulations may be perceived as inherently more threatening, unpleasant, or intense for a number of reasons including the internal vs. external origin as well as their novelty, controllability of the stimulation, and increased salience 11,12 . Indeed, we can assume that most if not all participants regularly experience both non‐painful and painful sensations on the outside of their body, while visceral sensations may not be as commonly experienced.…”

“…9 Given these anatomical and neurobiological differences, it is plausible that perceptual and emotional features, such as threat, intensity, and unpleasantness, also differ between visceral and somatic sensations. Indeed, prior experimental research suggests visceral pain is perceived as more unpleasant 10,11 and fear-evoking, 11 is associated with enhanced conditioned behavioral responses, 10 and contributes to higher levels of impairment in cognitive performance 12 compared to somatic pain.…”

Evaluation of bone mineral density and body compositions interrelation in young and middle-aged male patients with Crohn’s disease by quantitative computed tomography

“…VAT has been particularly related to a proinflammatory state and has been implicated in some gastrointestinal diseases, such as fatty liver, cancers, acute pancreatitis, and CD (28). Inflammatory factors secreted by VAT could increase bone resorption through stimulating osteoclast activity, including TNF-a, IL-6, and IL-8, which destroy bone cells and bone structure (29). These fat-releasing cytokines may also contribute to the debilitating musculoskeletal system observed in IBD patients (30,31).…”