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Thermal hypersensitivity in irritable bowel syndrome patients
Abstracts
S15
C04 Central Pain
C05 Complex Regional Pain Syndromes
(157) Ischemic hypersensitivity in irritable bowel syndrome patients
(159) A web-based survey of the spread of symptoms in Complex Regional Pain Syndrome (CRPS)
Q Zhou, J Riley, B Zhang, G Verne; Ohio State University, Columbus, OH Some investigators have shown greater sensitivity among IBS patients relative to controls for somatic thermal stimuli, while others indicate IBS-associated hypersensitivity is limited to the gut. However, whether somatic hypersensitivity in IBS would be observed in response to a deep, tonic somatic pain stimulus, ischemic arm pain, has not been determined. A total of 17 diarrhea predominant (D-IBS) and 9 constipation predominant (CIBS) IBS patients, and 29 healthy controls (C) participated in the study. The right arm was exsanguinated and occluded with a standard blood pressure cuff inflated to 240 mmHg. Subjects then performed 20 handgrip exercises of 2-sec duration at 4-sec intervals at 50% of their maximum grip strength. Subjects continued for 15 minutes or until the pain became intolerable. They then rated pain intensity on 0-100 Mechanical Visual Analogue Scale (M-VAS) every 60 seconds. All subjects completed the Functional Bowel Disease Severity Index Scale (FBDSI). Group differences were determined using a series of 1-way ANOVA tests. Both C-IBS (97 secs) and D-IBS (75 secs) patients had a shorter ischemic threshold compared to controls (275 secs) (p < 0.001). Similarly, both C-IBS (197 secs) and D-IBS (206 secs) patients had a shorter ischemic tolerance compared to controls (566 secs) (p < 0.001). The D-IBS (71) and C-IBS (53) patients had a greater mean FBDSI compared to controls (1) (p < 0.001). Our data suggest that a more widespread alteration in central pain processing in IBS patients may be present as they display hypersensitivity to ischemic arm pain. These findings could reflect a dysfunction in inhibitory pain systems in IBS patients, as ischemic (deep) pain may be under tonic inhibitory control. (Supported by a NIH RO1-NS053090 grant PI: GN Verne.)
D Mazloomdoost, S Agarwal, M Lesley, S Raja, J Broatch, A Sharma; Johns Hopkins Medical Institute, Baltimore, MD The symptoms and signs of CRPS have been reported to spread from the initial injury site to other parts of the same extremity, contra-lateral limb or remote regions. However, little is known about the frequency of neither spread nor factors that predict the spread. Data from an Internetbased survey of patients diagnosed with CRPS was examined to identify patterns of spread and to determine if demographic or clinical characteristics predict spread. CRPS patients who completed an initial survey on the Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) website were invited to complete a second wide-ranging survey. The survey included questions on demographics, disease onset and course, diagnosis, and effective treatment. Spread was categorized as contiguous, mirror-image, and remote. Statistical correlations were made using T-test, Chi-square, or Fisher’s Exact tests. Of subjects who completed the survey, 88.3% (264/299) were female and 44.8% (134/ 299) were between the ages of 45 and 55. Spread was reported in 83.2% (249/299) with 72.2% (174/241) reporting inadequate pain control prior to spread. Certain diagnostic criteria showed a correlation with increased likelihood of spread including increased sweating, color change, change in bowel functions, and local hair loss (p < 0.05). A higher proportion of patients who stated that a sympathetic nerve block was used as an additional diagnostic tool also showed an increased disposition to spread (p = 0.015). No correlation was observed between initial site or cause of injury and likelihood of spread. An inverse correlation exists between contiguous and remote spread (p = 0.025) with a trend towards a positive correlation between remote and mirror spread (p = 0.056). The survey suggests that CRPS patients with certain autonomic symptoms are more likely to have spread. Correlations between distinct patterns of spread, contiguous and remote, need to be examined more carefully with prospective studies.
(158) Thermal hypersensitivity in irritable bowel syndrome patients
C07 Joint and Muscle Pain
Q Zhou, G Verne, J Riley; Ohio State University, Columbus, OH Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that has significant comorbidity with somatic pain conditions such as fibromyalgia and migraine headaches. A total of 42 patients (29 Females, 13 Males; mean age 27.0 6 6.4 years) with D-IBS; 24 patients (16 Females, 8 Males; mean age 32.5 6 8.8 years) with C-IBS; and 52 controls (34 Females, 18 Males; mean age 27.3 6 8.0 years) participated in the study. A Medoc Thermal Sensory Analyzer with a 3cm x 3cm surface area was used. Heat Pain Threshold (HPTh) and Heat Pain Tolerance (HPTo) were assessed on the left ventral forearm and calf. All subjects completed the Functional Bowel Disease Severity Index Scale (FBDSI). Controls were less sensitive than C-IBS and D-IBS (both at p < .001) with no differences between C-IBS and D-IBS for both HPTh and HPTo. Thermal hyperalgesia was present for both groups of IBS patients on the forearm and calf relative to controls. Cluster analysis revealed the presence of 3 subgroups of IBS patients based on thermal hyperalgesia. One cluster (17%) had heat pain sensitivity similar to controls; another cluster (47%) had moderate heat pain sensitivity; a third cluster (36%) had high thermal hyperalgesia. The FBDSI was higher in IBS patients with high thermal hyperalgesia compared to IBS patients with low pain sensitivity and controls. A subset of IBS patients with a high FBDSI score have thermal hypersensitivity compared to controls. (This study was supported by a NIH RO1-NS053090 award PI: GN Verne.)
(160) Specific pain complaints in veterans with PTSD returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) T Moeller-Bertram, L Johnson Wright, N Madra, N Afari, D Baker; VA San Diego Healthcare Systems, San Diego, CA Post Traumatic Stress Disorder (PTSD) is a debilitating disorder with an elevated incidence in returning OEF/OIF veterans. PTSD and chronic pain are highly co-morbid and chronic pain patients report more severe PTSD. Surveys in the general population and among Vietnam veterans show that certain pain diagnoses are more likely to co-occur with PTSD. The purpose of the present study was to examine the association of PTSD with specific pain complaints in OEF/OIF veterans. Upon enrollment at the VA San Diego, 444 veterans completed a battery of self-report questionnaires. Veterans were primarily male (81%), with an average age of 32 years; close to 40% were white. PTSD was defined as a score of >40 on the Davidson Trauma Scale. Results from logistic regression analyses indicated that veterans with PTSD were significantly more likely to report the following pain complaints than veterans without PTSD: abdominal pain (OR = 3.6), muscle aches or cramps (OR = 3.2), joint aches (OR = 2.2), and back pain or spasms (OR = 2.1). Follow-up analyses compared 113 veterans with co-morbid PTSD and pain with 36 veterans with PTSD only, and found differences in rates of injury during combat (p < 0.01) and depression (p < 0.01). In logistic regression analyses with adjustments for age, gender, depression, and combat injury, the associations with muscle aches or cramps (OR = 2.5) and joint aches (OR = 2.0) remained significant, while abdominal pain approached significance (OR = 2.1). Overall, these findings in OEF/OIF veterans are consistent with prior reports in the general population, but suggest possible differences with Vietnam veterans. Future studies can further explore the potential role of age, depression, physical injury and other moderators in the relationship between PTSD and specific pain complaints in this population.
S15
C04 Central Pain
C05 Complex Regional Pain Syndromes
(157) Ischemic hypersensitivity in irritable bowel syndrome patients
(159) A web-based survey of the spread of symptoms in Complex Regional Pain Syndrome (CRPS)
Q Zhou, J Riley, B Zhang, G Verne; Ohio State University, Columbus, OH Some investigators have shown greater sensitivity among IBS patients relative to controls for somatic thermal stimuli, while others indicate IBS-associated hypersensitivity is limited to the gut. However, whether somatic hypersensitivity in IBS would be observed in response to a deep, tonic somatic pain stimulus, ischemic arm pain, has not been determined. A total of 17 diarrhea predominant (D-IBS) and 9 constipation predominant (CIBS) IBS patients, and 29 healthy controls (C) participated in the study. The right arm was exsanguinated and occluded with a standard blood pressure cuff inflated to 240 mmHg. Subjects then performed 20 handgrip exercises of 2-sec duration at 4-sec intervals at 50% of their maximum grip strength. Subjects continued for 15 minutes or until the pain became intolerable. They then rated pain intensity on 0-100 Mechanical Visual Analogue Scale (M-VAS) every 60 seconds. All subjects completed the Functional Bowel Disease Severity Index Scale (FBDSI). Group differences were determined using a series of 1-way ANOVA tests. Both C-IBS (97 secs) and D-IBS (75 secs) patients had a shorter ischemic threshold compared to controls (275 secs) (p < 0.001). Similarly, both C-IBS (197 secs) and D-IBS (206 secs) patients had a shorter ischemic tolerance compared to controls (566 secs) (p < 0.001). The D-IBS (71) and C-IBS (53) patients had a greater mean FBDSI compared to controls (1) (p < 0.001). Our data suggest that a more widespread alteration in central pain processing in IBS patients may be present as they display hypersensitivity to ischemic arm pain. These findings could reflect a dysfunction in inhibitory pain systems in IBS patients, as ischemic (deep) pain may be under tonic inhibitory control. (Supported by a NIH RO1-NS053090 grant PI: GN Verne.)
D Mazloomdoost, S Agarwal, M Lesley, S Raja, J Broatch, A Sharma; Johns Hopkins Medical Institute, Baltimore, MD The symptoms and signs of CRPS have been reported to spread from the initial injury site to other parts of the same extremity, contra-lateral limb or remote regions. However, little is known about the frequency of neither spread nor factors that predict the spread. Data from an Internetbased survey of patients diagnosed with CRPS was examined to identify patterns of spread and to determine if demographic or clinical characteristics predict spread. CRPS patients who completed an initial survey on the Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) website were invited to complete a second wide-ranging survey. The survey included questions on demographics, disease onset and course, diagnosis, and effective treatment. Spread was categorized as contiguous, mirror-image, and remote. Statistical correlations were made using T-test, Chi-square, or Fisher’s Exact tests. Of subjects who completed the survey, 88.3% (264/299) were female and 44.8% (134/ 299) were between the ages of 45 and 55. Spread was reported in 83.2% (249/299) with 72.2% (174/241) reporting inadequate pain control prior to spread. Certain diagnostic criteria showed a correlation with increased likelihood of spread including increased sweating, color change, change in bowel functions, and local hair loss (p < 0.05). A higher proportion of patients who stated that a sympathetic nerve block was used as an additional diagnostic tool also showed an increased disposition to spread (p = 0.015). No correlation was observed between initial site or cause of injury and likelihood of spread. An inverse correlation exists between contiguous and remote spread (p = 0.025) with a trend towards a positive correlation between remote and mirror spread (p = 0.056). The survey suggests that CRPS patients with certain autonomic symptoms are more likely to have spread. Correlations between distinct patterns of spread, contiguous and remote, need to be examined more carefully with prospective studies.
(158) Thermal hypersensitivity in irritable bowel syndrome patients
C07 Joint and Muscle Pain
Q Zhou, G Verne, J Riley; Ohio State University, Columbus, OH Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that has significant comorbidity with somatic pain conditions such as fibromyalgia and migraine headaches. A total of 42 patients (29 Females, 13 Males; mean age 27.0 6 6.4 years) with D-IBS; 24 patients (16 Females, 8 Males; mean age 32.5 6 8.8 years) with C-IBS; and 52 controls (34 Females, 18 Males; mean age 27.3 6 8.0 years) participated in the study. A Medoc Thermal Sensory Analyzer with a 3cm x 3cm surface area was used. Heat Pain Threshold (HPTh) and Heat Pain Tolerance (HPTo) were assessed on the left ventral forearm and calf. All subjects completed the Functional Bowel Disease Severity Index Scale (FBDSI). Controls were less sensitive than C-IBS and D-IBS (both at p < .001) with no differences between C-IBS and D-IBS for both HPTh and HPTo. Thermal hyperalgesia was present for both groups of IBS patients on the forearm and calf relative to controls. Cluster analysis revealed the presence of 3 subgroups of IBS patients based on thermal hyperalgesia. One cluster (17%) had heat pain sensitivity similar to controls; another cluster (47%) had moderate heat pain sensitivity; a third cluster (36%) had high thermal hyperalgesia. The FBDSI was higher in IBS patients with high thermal hyperalgesia compared to IBS patients with low pain sensitivity and controls. A subset of IBS patients with a high FBDSI score have thermal hypersensitivity compared to controls. (This study was supported by a NIH RO1-NS053090 award PI: GN Verne.)
(160) Specific pain complaints in veterans with PTSD returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) T Moeller-Bertram, L Johnson Wright, N Madra, N Afari, D Baker; VA San Diego Healthcare Systems, San Diego, CA Post Traumatic Stress Disorder (PTSD) is a debilitating disorder with an elevated incidence in returning OEF/OIF veterans. PTSD and chronic pain are highly co-morbid and chronic pain patients report more severe PTSD. Surveys in the general population and among Vietnam veterans show that certain pain diagnoses are more likely to co-occur with PTSD. The purpose of the present study was to examine the association of PTSD with specific pain complaints in OEF/OIF veterans. Upon enrollment at the VA San Diego, 444 veterans completed a battery of self-report questionnaires. Veterans were primarily male (81%), with an average age of 32 years; close to 40% were white. PTSD was defined as a score of >40 on the Davidson Trauma Scale. Results from logistic regression analyses indicated that veterans with PTSD were significantly more likely to report the following pain complaints than veterans without PTSD: abdominal pain (OR = 3.6), muscle aches or cramps (OR = 3.2), joint aches (OR = 2.2), and back pain or spasms (OR = 2.1). Follow-up analyses compared 113 veterans with co-morbid PTSD and pain with 36 veterans with PTSD only, and found differences in rates of injury during combat (p < 0.01) and depression (p < 0.01). In logistic regression analyses with adjustments for age, gender, depression, and combat injury, the associations with muscle aches or cramps (OR = 2.5) and joint aches (OR = 2.0) remained significant, while abdominal pain approached significance (OR = 2.1). Overall, these findings in OEF/OIF veterans are consistent with prior reports in the general population, but suggest possible differences with Vietnam veterans. Future studies can further explore the potential role of age, depression, physical injury and other moderators in the relationship between PTSD and specific pain complaints in this population.