Psychobiologische Mechanismen bei der Pathophysiologie chronischer viszeraler Schmerzen

Abstract

Although visceral pain is of high clinical relevance, it remains poorly understood especially when compared to somatic pain. Nevertheless, interdisciplinary research approaches bridging psychophysiology and neurogastroenterology have contributed to a more refined knowledge about the complex peripheral and central mechanisms of the bidirectional brain-gut axis in recent years. This review summarizes current knowledge regarding psychobiological mechanisms in the pathophysiology of chronic visceral pain in functional gastrointestinal disorders with a focus on irritable bowel syndrome (IBS). Special attention is paid to the role of affective disturbances and emotions, particularly psychological stress as well as to influences of cognition and learning on gastrointestinal motor and sensory functions in healthy individuals and patients with IBS. In this emerging field of research, new evidence from the fields of placebo research and pain-related fear conditioning provide new insights into the psychological and neurobiological mechanisms involved in the transition from acute to chronic pain and the maintenance of pain. This opens up new perspectives for innovative treatment approaches for IBS and other functional gastrointestinal disorders.

Heart rate variability characteristics of patients with irritable bowel syndrome and associations with symptoms

“…In many patients, pathophysiological characteristics such as altered GI motility and visceral hypersensitivity, but also altered central pain processing have been reported . These findings can potentially be explained by an altered function of the nervous system, such as a dysfunctional afferent signaling, dysfunctional central pain processing or increased responsiveness to environmental factors such as stress . Due to these observations, the brain‐gut axis, ie, the bidirectional brain‐gut communication network, has become focus of recent research and is a promising candidate in the quest to improve the understanding of IBS pathophysiology …”

Small-Conductance Ca2+-Activated K+ Channel 2 in the Dorsal Horn of Spinal Cord Participates in Visceral Hypersensitivity in Rats

“…Visceral hypersensitivity is a hallmark of irritable bowel syndrome and other gastrointestinal disorders that cause pain. The mechanism of visceral hypersensitivity and pain is still poorly understood due to the diverse nature of visceral hypersensitivity compounded by multiple factors such as sexual dimorphism, psychological and physical stresses, genetic and epigenetic traits, and the nature of predisposed disease ( Chen et al, 2015 ; Elsenbruch and Enck, 2016 ). We recently demonstrated that early life stresses, for example, neonatal colorectal distension (CRD), maternal separation, could induce visceral hypersensitivity in rats ( Wang et al, 2016 ; Zhang et al, 2016a , b ).…”

A review of neuroendocrine immune system abnormalities in IBS based on the brain–gut axis and research progress of acupuncture intervention

“…The intestinal mucosal immune system is composed of intestinal epithelial cells, intestinal interepithelial lymphocytes, lymphocytes of the lamina propria, intestinal submucosal-collecting lymph nodes, and various monocytes, which directly participate in intestinal immune regulation. Some studies have confirmed the presence of abnormal mucosal immunity in patients with IBS (Aerssens et al, 2008 ), and stress factors are thought to be strongly associated with the development of IBS (Elsenbruch and Enck, 2016 ). Stress regulates the intestinal immune system by triggering the brain–gut axis to produce neurotransmitters and hormones.…”