Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity
Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity
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DOI：
10.1136/gut.2006.117390
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发表时间：
2007-09-01
期刊：
影响因子：
24.5
通讯作者：
Whitehead, William E.
中科院分区：
文献类型：
--
作者：
Dorn, Spencer D.;Palsson, Olafur S.;Whitehead, William E.
目的：探讨肠易激综合征(IBS)患者较低的内脏痛阈值是否主要反映生理或心理因素。方法：首先，对121例肠易激综合征患者和28例对照组进行降结肠气囊扩张，采用升限法(AML)评估痛觉和冲动阈值。其次，使用感觉决策理论分析来分离知觉的生理和心理成分：神经感觉敏感度(p(A))是通过区分30 mm Hg和34 mm Hg扩张的能力来衡量的；心理影响是通过报告标准来衡量的-即报告疼痛的总体趋势，以所有扩张的中值强度评级为指数，与强度无关。结果：肠易激综合征患者的急性髓细胞白血病痛阈值较低(中位数：28 mm Hgvs40 mm Hg；p<；0.001)，但神经感觉敏感度相似(中位数p(A)：0.5vs0.5；p=0.69；42.6%vs42.9%，比偶然更好地区分刺激)和更大的报告疼痛的倾向(中位数报告标准：4.0vs5.2(轻微的)疼痛；p=0.003)。急性髓系白血病痛阈值与神经感觉敏感度无相关性(r=-0.13；p=0.14)，但与报告标准显著相关(r=0.67；p<；0.0001)。报告标准与躯体化评分呈负相关(r=-0.26，p=0.001)，与躯体化评分呈负相关(r=-0.18，p=0.035)。在非痛性紧迫感方面也有类似的结果。结论：IBS患者结肠敏感性的增加主要受报告疼痛和冲动的心理倾向的影响，而不是神经感觉敏感性的增加。
Objective: The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors.Methods: Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30 mm Hg vs 34 mm Hg distensions; psychological influences were measured by the report criterion - that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI).Results: IBS patients had lower AML pain thresholds (median: 28 mm Hg vs 40 mm Hg; p < 0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p = 0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 ("mild" pain) vs 5.2 ("weak" pain); p = 0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r = -0.13; p = 0.14), but were strongly correlated with report criterion (r = 0.67; p < 0.0001). Report criterion was inversely correlated with BSI somatisation (r = -0.26; p = 0.001) and BSI global score (r = -0.18; p = 0.035). Similar results were seen for the non-painful sensation of urgency.Conclusion: Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity.