Skip to main content
SpringerLink
Log in

Psychophysiologische Grundlagen viszeraler Schmerzen

Psychophysiology of visceral pain

  • Schwerpunkt
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Die Psychophysiologie viszeraler Schmerzen ist aufgrund der Invasivität ihrer Methoden und der Schwierigkeit, im Gastrointestinaltrakt verlässlich und reproduzierbar zu stimulieren und abzuleiten, weniger gut untersucht als beispielsweise die kardiale Psychophysiologie. Dennoch wurden in den vergangenen 30 Jahren eine Reihe von psychophysiologischen Phänomenen, beispielsweise die Wahrnehmung (Interozeption) viszeraler Stimuli, die Auswirkung von Emotionen und Belastungen auf viszerale Sensationen und der Einfluss viszeraler Vorgänge auf kortikale Verarbeitungsmuster, verlässlich dokumentiert und Unterschiede zwischen Gesunden und Patienten mit viszeralen Schmerzsyndromen untersucht. Als hilfreich hat sich v. a. die Anwendung neurophysiologischer Verfahren (kortikale Bildgebung und Stimulation) in den Untersuchungen erwiesen.

Abstract

The psychophysiology of visceral pain is—different from cardiac psychophysiology—much less well investigated due to the invasiveness of its methods and problems associated with reliably and reproducibly stimulating as well as recording of the gastrointestinal tract. Despite these problems, the last 30 years have documented a number of psychophysiological phenomena such as the perception (interoception) of visceral stimuli, the effect of emotions and stress on visceral sensations, and the effect of visceral processes on cortical processing. This was mainly due to the application of neurophysiological techniques (cortical imaging and stimulation) in these investigations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Beaumont W (1833) Experiments and observations on the gastric juice and the physiology of digestion. F.P.Allen, Plattsburgh, PA, USA (deutsch: Neue Versuche und Beobachtungen über den Magensaft und die Physiologie der Verdauun. C.E.Kollmann, Leipzig 1834)

  2. Engel GL, Reichsman F, Segal HL (1956) A study of an infant with a gastric fistula, I: behavior and the rate of total hydrochloric acid secretion. Psychosom Med 18:374–398

    Article  CAS  PubMed  Google Scholar 

  3. Wolff HG, Wolf S (1943) Human gastric function. Oxford University Press, New York

  4. Cannon WB (1915) Bodily changes in pain, hunger, fear and rage. D.Appleton & Co, New York (deutsch: Wut, Hunger, Angst und Schmerz: eine Physiologie der Emotionen. Urban & Schwarzenberg, München/Berlin/Wien 1975)

  5. Almy TP, Fielding J (1977) The GI tract in stress and psychosocial disorder. Saunders, Philadelphia

  6. Whitehead WE, Delvaux M (1997) Standardization of barostat procedures for testingsmooth muscle tone and sensory thresholds in the gastrointestinal tract. The Working Team of Glaxo-Wellcome Research, UK. Dig Dis Sci 42:223–241

    Article  CAS  PubMed  Google Scholar 

  7. Keszthelyi D, Troost FJ, Masclee AA (2012) Irritable bowel syndrome: methods, mechanisms, and pathophysiology. Methods to assess visceral hypersensitivity in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 303:G141–G154

    Article  CAS  PubMed  Google Scholar 

  8. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 63(Suppl 11):S240–S252

    Article  Google Scholar 

  9. Spiegel B, Bolus R, Harris LA et al (2009) Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scale. Aliment Pharmacol Ther 30:1159–1170

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Enck P, Martens U (2008) Der nächste Konsensus zum Reizdarmsyndrom muss interdisziplinär sein. Z Gastroenterol 46:211–215

    Article  CAS  PubMed  Google Scholar 

  11. Paine P, Kishor J, Worthen SF et al (2009) Exploring relationships for visceral and somatic pain with autonomic control and personality. Pain 144:236–244

    Article  PubMed  Google Scholar 

  12. Coen SJ, Gregory LJ, Yágüez L et al (2007) Reproducibility of human brain activity evoked by esophageal stimulation using functional magnetic resonance imaging. Am J Physiol Gastrointest Liver Physiol 293:G188–G197

    Article  CAS  PubMed  Google Scholar 

  13. Harris ML, Hobson AR, Hamdy S et al (2006) Neurophysiological evaluation of healthy human anorectal sensation. Am J Physiol Gastrointest Liver Physiol 291:G950–G958

    Article  CAS  PubMed  Google Scholar 

  14. Enck P, Kaiser C, Felber M et al (2009) Circadian variation of rectal sensitivity and gastrointestinal peptides in healthy volunteers. Neurogastroenterol Motil 21:52–58

    Article  CAS  PubMed  Google Scholar 

  15. Hagger R, Kumar D, Benson M, Grundy A (2002) Periodic colonic motor activity identified by 24-h pancolonic ambulatory manometry in humans. Neurogastroenterol Motil 14:271–278

    Article  CAS  PubMed  Google Scholar 

  16. Mayer EA, Gebhart GF (1994) Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 107:271–293

    CAS  PubMed  Google Scholar 

  17. Keszthelyi D, Troost FJ, Simrén M et al (2012) Revisiting concepts of visceral nociception in irritable bowel syndrome. Eur J Pain 16:1444–1454

    Article  CAS  PubMed  Google Scholar 

  18. Ritchie J (1973) Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Whitehead WE, Holtkotter B, Enck P et al (1990) Tolerance for rectosigmoid distention in irritable bowel syndrome. Gastroenterology 98:1187–1192

    CAS  PubMed  Google Scholar 

  20. Brock C, Nissen TD, Gravesen FH et al (2008) Multimodal sensory testing of the rectum and rectosigmoid: development and reproducibility of a new method. Neurogastroenterol Motil 20:908–918

    Article  CAS  PubMed  Google Scholar 

  21. Tu FF, Fitzgerald CM, Kuiken T et al (2008) Vaginal pressure-pain thresholds: initial validation and reliability assessment in healthy women. Clin J Pain 24:45–50

    Article  PubMed  Google Scholar 

  22. Horing B, Kugel H, Brenner V et al (2013) Perception and pain thresholds for cutaneous heat and cold, and rectal distension: associations and disassociations. Neurogastroenterol Motil 25:e791–e802

    Article  CAS  PubMed  Google Scholar 

  23. Rohrböck RB, Hammer J, Vogelsang H et al (2004) Acupuncture has a placebo effect on rectal perception but not on distensibility and spatialnsummation: a study in health and IBS. Am J Gastroenterol 99:1990–1997

    Article  PubMed  Google Scholar 

  24. Drewes AM, Pedersen J, Reddy H et al (2006) Central sensitization in patients with non-cardiac chest pain: a clinical experimental study. Scand J Gastroenterol 41:640–649

    Article  PubMed  Google Scholar 

  25. Pan HL, Longhurst JC (1996) Ischaemia-sensitive sympathetic afferents innervating the gastrointestinal tract function as nociceptors in cats. J Physiol 492:841–850

    CAS  PubMed Central  PubMed  Google Scholar 

  26. Bouhassira D, Chollet R, Coffin B et al (1994) Inhibition of a somatic nociceptive reflex by gastric distention in humans. Gastroenterology 107:985–992

    CAS  PubMed  Google Scholar 

  27. Bouhassira D, Sabaté JM, Coffin B et al (1998) Effects of rectal distensions on nociceptive flexion reflexes in humans. Am J Physiol 275:G410–G417

    CAS  PubMed  Google Scholar 

  28. Giamberardino MA, Costantini R, Affaitati G et al (2010) Viscero-visceral hyperalgesia: characterization in different clinical models. Pain 151:307–322

    Article  PubMed  Google Scholar 

  29. Coffin B, Bouhassira D, Sabaté JM et al (2004) Alteration of the spinal modulation of nociceptive processing in patients with irritable bowel syndrome. Gut 53:1465–1470

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Bouhassira D, Moisset X, Jouet P et al (2013) Changes in the modulation of spinal pain processing are related to severity in irritable bowel syndrome. Neurogastroenterol Motil 25:623-e468

    Article  CAS  PubMed  Google Scholar 

  31. Yarnitsky D (2010) Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. Curr Opin Anaesthesiol 23:611–615

    Article  PubMed  Google Scholar 

  32. Brock C, Olesen SS, Valeriani M et al (2012) Brain activity in rectosigmoid pain: unravelling conditioning pain modulatory pathways. Clin Neurophysiol 123:829–837

    Article  PubMed  Google Scholar 

  33. Chalaye P, Goffaux P, Bourgault P et al (2012) Comparing pain modulation and autonomic responses in fibromyalgia and irritable bowel syndrome patients. Clin J Pain 28:519–526

    Article  PubMed  Google Scholar 

  34. Przekop P, Haviland MG, Zhao Y et al (2012) Self-reported physical health, mental health, and comorbid diseases among women with irritable bowel syndrome, fibromyalgia, or both compared with healthy control respondents. J Am Osteopath Assoc 112:726–733

    PubMed Central  PubMed  Google Scholar 

  35. Chang L, Mayer EA, Johnson T et al (2000) Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia. Pain 84:297–307

    Article  CAS  PubMed  Google Scholar 

  36. Cameron OG (2001) Interoception: the inside story – a model for psychosomaticprocesses. Psychosom Med 3:697–710

    Article  Google Scholar 

  37. Schandry R (1981) Heart beat perception and emotional experience. Psychophysiology 18:483–488

    Article  CAS  PubMed  Google Scholar 

  38. Whitehead WE, Drescher VM (1980) Perception of gastric contractions and self-control of gastric motility. Psychophysiology 17:552–558

    Article  CAS  PubMed  Google Scholar 

  39. Koch KL, Stewart WR, Stern RM (1987) Effect of barium meals on gastric electromechanical activity in man. A fluoroscopic-electrogastrographic study. Dig Dis Sci 32:1217–1222

    Article  CAS  PubMed  Google Scholar 

  40. Koch KL, Hong SP, Xu L (2000) Reproducibility of gastric myoelectrical activity and the water load test in patients with dysmotility-like dyspepsia symptoms and in control subjects. J Clin Gastroenterol 31:125–129

    Article  CAS  PubMed  Google Scholar 

  41. Herbert BM, Muth ER, Pollatos O, Herbert C (2012) Interoception across modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions. PLoS One 7:e36646

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Enck P, Hefner J, Herbert BM et al (2013) Sensitivity and specificity of hypnosis effects on gastric myoelectrical activity. PLoS One 8:e83486

    Article  PubMed Central  PubMed  Google Scholar 

  43. Horing B, Weimer K, Schrade D et al (2013) Reduction of motion sickness with an enhanced placebo instruction: an experimental study with healthy participants. Psychosom Med 75:497–504

    Article  PubMed  Google Scholar 

  44. Enck P, Holtmann G (1992) Stress and gastrointestinal motility in animals – a review of the literature. J Gastrointest Motil 4:83–90

    Article  Google Scholar 

  45. Holtmann G, Enck P (1991) Stress and gastrointestinal motility in humans – a review of the literature. J Gastrointest Motil 3:245–254

    Article  Google Scholar 

  46. Blanchard EB, Lackner JM, Jaccard J et al (2008) The role of stress in symptom exacerbation among IBS patients. J Psychosom Res 64:119–128

    Article  PubMed  Google Scholar 

  47. Layer P, Andresen V, Pehl C et al (2011) Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management. Z Gastroenterol 49:237–293

    Article  CAS  PubMed  Google Scholar 

  48. Singh S, Blanchard A, Walker JR et al (2011) Common symptoms and stressors among individuals with inflammatory bowel diseases. Clin Gastroenterol Hepatol 9:769–775

    Article  PubMed  Google Scholar 

  49. Levenstein S, Prantera C, Varvo V et al (2000) Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol 95:1213–1220

    Article  CAS  PubMed  Google Scholar 

  50. Phillips ML, Gregory LJ, Cullen S et al (2003) The effect of negative emotional context on neural and behavioural responses to oesophageal stimulation. Brain 126:669–684

    Article  PubMed  Google Scholar 

  51. Sarkar S, Aziz Q, Woolf CJ et al (2000) Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet 356:1154–1159

    Article  CAS  PubMed  Google Scholar 

  52. Farmer AD, Coen SJ, Kano M et al (2013) Psychophysiological responses to pain identify reproducible human clusters. Pain 154:2266–2276

    Article  CAS  PubMed  Google Scholar 

  53. Enck P, Bingel U, Schedlowski M, Rief W (2013) The placebo response in medicine: minimize, maximize or personalize? Nat Rev Drug Discov 12:191–204

    Article  CAS  PubMed  Google Scholar 

  54. Verne GN, Robinson ME, Vase L, Price DD (2003) Reversal of visceral and cutaneous hyperalgesia by local rectal anesthesia in irritable bowel syndrome (IBS) patients. Pain 105:223–230

    Article  PubMed  Google Scholar 

  55. Verne GN, Sen A, Price DD (2005) Intrarectal lidocaine is an effective treatment for abdominal pain associated with diarrhea-predominant irritable bowel syndrome. J Pain 6:493–496

    Article  CAS  PubMed  Google Scholar 

  56. Vase L, Robinson ME, Verne GN, Price DD (2003) The contributions of suggestion, desire, and expectation to placebo effects in irritable bowel syndrome patients. An empirical investigation. Pain 105:17–25

    Article  PubMed  Google Scholar 

  57. Vase L, Robinson ME, Verne GN, Price DD (2005) Increased placebo analgesia over time in irritable bowel syndrome (IBS) patients is associated with desire and expectation but not endogenous opioid mechanisms. Pain 115:338–347

    Article  PubMed  Google Scholar 

  58. Elsenbruch S, Schmid J, Bäsler M et al (2012) How positive and negative expectations shape the experience of visceral pain: an experimental pilot study in healthy women. Neurogastroenterol Motil 24:914-e460

    Article  CAS  PubMed  Google Scholar 

  59. Elsenbruch S, Kotsis V, Benson S et al (2012) Neural mechanisms mediating the effects of expectation in visceral placebo analgesia: an fMRI study in healthy placebo responders and nonresponders. Pain 153:382–390

    Article  PubMed  Google Scholar 

  60. Petrovic P, Kalso E, Petersson KM, Ingvar M (2002) Placebo and opioid analgesia – imaging a shared neuronal network. Science 29:1737–1740

    Article  Google Scholar 

  61. Bingel U, Lorenz J, Schoell E et al (2006) Mechanisms of placebo analgesia: rACC recruitment of a subcortical antinociceptive network. Pain 12:8–15

    Article  Google Scholar 

  62. Kong J, Kaptchuk TJ, Polich G et al (2009) An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment. Neuroimage 47:1066–1076

    Article  PubMed Central  PubMed  Google Scholar 

  63. Scott DJ, Stohler CS, Egnatuk CM et al (2008) Placebo and nocebo effects are defined by opposite opioid and dopaminergic responses. Arch Gen Psychiatry 65:220–231

    Article  PubMed  Google Scholar 

  64. Watson A, El-Deredy W, Iannetti GD et al (2009) Placebo conditioning and placebo analgesia modulate a common brain network during pain anticipation and perception. Pain 145:24–30

    Article  PubMed Central  PubMed  Google Scholar 

  65. Benedetti F, Amanzio M, Rosato R, Blanchard C (2011) Nonopioid placebo analgesia is mediated by CB1 cannabinoid receptors. Nat Med 17:1228–1230

    Article  CAS  PubMed  Google Scholar 

  66. Eippert F, Bingel U, Schoell ED et al (2009) Activation of the opioidergic descending pain control system underlies placebo analgesia. Neuron 63:533–543

    Article  CAS  PubMed  Google Scholar 

  67. Krummenacher P, Candia V, Folkers G et al (2010) Prefrontalcortex modulates placebo analgesia. Pain 148:368–374

    Article  PubMed  Google Scholar 

  68. Horing B (2014) Placebo effects and their prediction across multiple experimentally induced symptoms: motion sickness, cutaneous heat and cold pain, and rectal distension. Dissertation, Universität Tübingen

  69. Chapin H, Bagarinao E, Mackey S (2012) Real-time fMRI applied to pain management. Neurosci Lett 520:174–181

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Frieling T, Enck P, Wienbeck M (1989) Cerebral responses evoked by electrical stimulation of rectosigmoid in normal subjects. Dig Dis Sci 34:202–205

    Article  CAS  PubMed  Google Scholar 

  71. Frieling T, Enck P, Wienbeck M (1989) Cerebral responses evoked by electrical stimulation of the esophagus in normal subjects. Gastroenterology 97:475–478

    CAS  PubMed  Google Scholar 

  72. Loose R, Schnitzler A, Sarkar S et al (1999) Cortical activation during mechanical esophageal stimulation: a neuromagnetic study. Neurogastroenterol Motil 11:163–171

    Article  CAS  PubMed  Google Scholar 

  73. Binkofski F, Schnitzler A, Enck P et al (1998) Somatic and limbic cortex activcation in esophageal distension: A functional magnetic resonance imaging study. Ann Neurol 44:811–815

    Article  CAS  PubMed  Google Scholar 

  74. Rapps N, Oudenhove L van, Enck P, Aziz Q (2008) Brain imaging of visceral functions in healthy volunteers and IBS patients. J Psychosom Res 64:599–604

    Article  PubMed  Google Scholar 

  75. Chapin H, Bagarinao E, Mackey S (2012) Real-time fMRI applied to pain management. Neurosci Lett 520:174–181

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  76. Liu Y, Gao JH, Liu HL, Fox PT (2000) The temporal response of the brain after eating revealed by functional MRI. Nature 405:1058–1062

    Article  CAS  PubMed  Google Scholar 

  77. Heni M, Kullmann S, Ketterer C et al (2014) Differential effect of glucose ingestion on the neural processing of food stimuli in lean and overweight adults. Hum Brain Mapp 35:918-928

    Article  PubMed  Google Scholar 

  78. Frank S, Unholzer T, Bauer UM et al (2014) Dopamine depletion leads to altered reward, homeostatic and prefrontal activity in lean and obese volunteers. Abstract HBM (im Druck)

  79. Tillisch K, Labus J, Kilpatrick L et al (2013) Consumption of fermented milk product with probiotic modulates brain activity. Gastroenterology 144:1394–1401, 1401.e1–4

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Horing und P. Enck geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung Innere Medizin VI, Universitätsklinikum Tübingen, Frondsbergstr. 23, 72076, Tübingen, Deutschland

    B. Horing &  P. Enck

Authors
  1. B. Horing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Enck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Enck.

Additional information

Dieser Beitrag wurde durch Mittel des Forschungsstipendiums Günther Jantschek des Deutschen Kollegiums für Psychosomatische Medizin unterstützt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Horing, B., Enck, P. Psychophysiologische Grundlagen viszeraler Schmerzen. Schmerz 28, 252–258 (2014). https://doi.org/10.1007/s00482-014-1403-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-014-1403-9

Schlüsselwörter

Keywords

Search

Navigation