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Leifeld L, Germer CT, Böhm S, Dumoulin FL, Frieling T, Kreis M, Meining A, Labenz J, Lock JF, Ritz JP, Schreyer A, Kruis W. S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:613-688. [PMID: 35388437 DOI: 10.1055/a-1741-5724] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ludger Leifeld
- Medizinische Klinik 3 - Gastroenterologie und Allgemeine Innere Medizin, St. Bernward Krankenhaus, Hildesheim, apl. Professur an der Medizinischen Hochschule Hannover
| | - Christoph-Thomas Germer
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Würzburg
| | - Stephan Böhm
- Spital Bülach, Spitalstrasse 24, 8180 Bülach, Schweiz
| | | | - Thomas Frieling
- Medizinische Klinik II, Klinik für Gastroenterologie, Hepatologie, Infektiologie, Neurogastroenterologie, Hämatologie, Onkologie und Palliativmedizin HELIOS Klinikum Krefeld
| | - Martin Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Meining
- Medizinische Klinik und Poliklinik 2, Zentrum für Innere Medizin (ZIM), Universitätsklinikum Würzburg, Würzburg
| | - Joachim Labenz
- Abteilung für Innere Medizin, Evang. Jung-Stilling-Krankenhaus, Siegen
| | - Johan Friso Lock
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Würzburg
| | - Jörg-Peter Ritz
- Klinik für Allgemein- und Viszeralchirurgie, Helios Klinikum Schwerin
| | - Andreas Schreyer
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Brandenburg Theodor Fontane Klinikum Brandenburg, Brandenburg, Deutschland
| | - Wolfgang Kruis
- Medizinische Fakultät, Universität Köln, Köln, Deutschland
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From Anticipation to the Experience of Pain: The Importance of Visceral Versus Somatic Pain Modality in Neural and Behavioral Responses to Pain-Predictive Cues. Psychosom Med 2019; 80:826-835. [PMID: 29870435 DOI: 10.1097/psy.0000000000000612] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to compare behavioral and neural anticipatory responses to cues predicting either somatic or visceral pain in an associative learning paradigm. METHODS Healthy women (N = 22) underwent functional magnetic resonance imaging. During an acquisition phase, two different visual cues repeatedly signalled either experimental visceral or somatic pain. In a subsequent extinction phase, identical cues were presented without pain. Before and after each phase, cue valence and contingency awareness were assessed on visual analog scales. RESULTS Visceral compared to somatic pain-predictive cues were rated as more unpleasant after acquisition (visceral, 32.18 ± 13.03 mm; somatic, -18.36 ± 10.36 mm; p = .021) with similarly accurate cue-pain contingencies. After extinction, cue valence returned to baseline for both modalities (visceral, 1.55 ± 9.81 mm; somatic, -18.45 ± 7.12; p = .41). During acquisition, analyses of cue-induced neural responses revealed joint neural activation engaging areas associated with attention processing and cognitive control. Enhanced deactivation of posterior insula to visceral cues was observed, which correlated with enhanced responses within the salience network (anterior cingulate cortex, anterior insula) during visceral compared to somatic pain stimulation. During extinction, both pain modalities induced anticipatory neural activation in the extinction and salience network (all pFWE values < .05). CONCLUSIONS Conditioned emotional responses to pain-predictive cues are modality specific and enhanced for the visceral modality, suggesting that pain anticipation is shaped by the salience of painful stimuli. Common but also modality-specific neural mechanisms are involved during cue-pain learning, whereas extinction of cued responses seems unaffected by modality. Future research should examine potential implications for the pathophysiology of chronic pain conditions, especially chronic visceral pain.
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Herpertz SC, Schmitgen MM, Fuchs C, Roth C, Wolf RC, Bertsch K, Flor H, Grinevich V, Boll S. Oxytocin Effects on Pain Perception and Pain Anticipation. THE JOURNAL OF PAIN 2019; 20:1187-1198. [PMID: 31009765 DOI: 10.1016/j.jpain.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/11/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
There is an ongoing debate whether the neuropeptide oxytocin (OT) modulates pain processing in humans. This study differentiates behavioral and neuronal OT effects on pain perception and pain anticipation by using a Pavlovian conditioning paradigm. Forty-six males received intranasally administered OT in a randomized, double-blind, placebo-controlled group design. Although OT exerted no direct effect on perceived pain, OT was found to modulate the blood oxygen level-dependent response in the ventral striatum for painful versus warm unconditioned stimuli and to decrease activity in the anterior insula (IS) with repeated thermal pain stimuli. Regarding pain anticipation, OT increased responses to CSpain versus CSminus in the nucleus accumbens. Furthermore, in the OT condition increased correct expectations, particularly for the most certain conditioned stimuli (CS)-unconditioned stimuli associations (CSminus and CSpain) were found, as well as greatest deactivations in the right posterior IS in response to the least certain condition (CSwarm) with posterior IS activity and correct expectancies being positively correlated. In conclusion, OT seems to have both a direct effect on pain processing via the ventral striatum and by inducing habituation in the anterior IS as well as on pain anticipation by boostering associative learning in general and the neuronal conditioned fear of pain response in particular. PERSPECTIVE: The neuropeptide OT has recently raised the hope to offer a novel avenue for modulating pain experience. This study found OT to modulate pain processing and to facilitate the anticipation of pain, inspiring further research on OT effects on the affective dimension of the pain experience.
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Affiliation(s)
- Sabine C Herpertz
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Mike M Schmitgen
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christine Fuchs
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Corinna Roth
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health Mannheim, University of Heidelberg, Mannheim, Germany
| | - Valery Grinevich
- Schaller Research Group on Neuropeptides, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - Sabrina Boll
- Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
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Pitiot A, Smith JK, Humes DJ, Garratt J, Francis ST, Gowland PA, Spiller RC, Marciani L. Cortical differences in diverticular disease and correlation with symptom reports. Neurogastroenterol Motil 2018; 30:e13303. [PMID: 29392838 DOI: 10.1111/nmo.13303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent studies have shown that the brain of patients with gastrointestinal disease differ both structurally and functionally from that of controls. Highly somatizing diverticular disease (HSDD) patients were also shown to differ from low somatizing (LSDD) patients functionally. This study aimed to investigate how they differed structurally. METHODS Four diseases subgroups were studied in a cross-sectional design: 20 patients with asymptomatic diverticular disease (ADD), 18 LSDD, 16 HSDD, and 18 with irritable bowel syndrome. We divided DD patients into LSDD and HSDD using a cutoff of 6 on the Patient Health Questionnaire 12 Somatic Symptom (PHQ12-SS) scale. All patients underwent a 1-mm isotropic structural brain MRI scan and were assessed for somatization, hospital anxiety, depression, and pain catastrophizing. Whole brain volumetry, cortical thickness analysis and voxel-based morphometry were carried out using Freesurfer and SPM. KEY RESULTS We observed decreases in gray matter density in the left and right dorsolateral prefrontal cortex (dlPFC), and in the mid-cingulate and motor cortex, and increases in the left (19, 20) and right (19, 38) Brodmann Areas. The average cortical thickness differed overall across groups (P = .002) and regionally: HSDD > ADD in the posterior cingulate cortex (P = .03), HSDD > LSDD in the dlPFC (P = .03) and in the ventrolateral PFC (P < .001). The thickness of the anterior cingulate cortex and of the mid-prefrontal cortex were also found to correlate with Pain Catastrophizing (Spearman's ρ = 0.24, P = .043 uncorrected and Spearman's ρ = 0.25, P = .03 uncorrected). CONCLUSION & INFERENCES This is the first study of structural gray matter abnormalities in diverticular disease patients. The data show brain differences in the pain network.
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Affiliation(s)
- A Pitiot
- Laboratory of Image & Data Analysis, Ilixa Ltd., Nottingham, UK
| | - J K Smith
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - D J Humes
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - J Garratt
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - S T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - P A Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - R C Spiller
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - L Marciani
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Jin L, Yang X, Liu P, Sun J, Chen F, Xu Z, Qin W, Tian J. Dynamic abnormalities of spontaneous brain activity in women with primary dysmenorrhea. J Pain Res 2017; 10:699-707. [PMID: 28392711 PMCID: PMC5373826 DOI: 10.2147/jpr.s121286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This study aimed to investigate the regional spontaneous brain activity changes in primary dysmenorrhea (PD) patients in different phases of the menstrual cycle by regional homogeneity (ReHo) analysis. PATIENTS AND METHODS Thirty-three PD patients and 32 healthy controls (HCs) separately received resting-state functional magnetic resonance imaging during menstrual phase and follicular phase (non-menstrual phase). Cox retrospective symptom scale (RSS), Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were applied to assess related symptoms and emotions. RESULTS There was no significant difference between the two groups in demographic data. The PD patients obtained higher RSS score, SAS score and SDS score than HCs. Compared with HCs, the ReHo values of the PD patients were increased in left midbrain and hippocampus, right posterior cingulate cortex (PCC), insula and middle temporal cortex (MTC) and decreased in left dorsolateral prefrontal cortex and right medial prefrontal cortex (mPFC) in menstrual phase. In non-menstrual phase, enhanced ReHo values were found in bilateral S1 and precuneus, left S2 and MTC, and reduced ReHo values were observed in left mPFC and orbital frontal cortex. RSS score positively correlated with ReHo values of midbrain and negatively correlated with mPFC and PCC. CONCLUSION Our results suggested that PD is accompanied by dynamic regional spontaneous activity changes across the menstrual cycle, and the altered regions were involved in descending pain modulation, default mode network and sensory modulation. These abnormal activations might contribute to maintain the menstrual pain.
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Affiliation(s)
- Lingmin Jin
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Xuejuan Yang
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Peng Liu
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Jinbo Sun
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Fei Chen
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Ziliang Xu
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Wei Qin
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Jie Tian
- Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
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Abstract
Although over half of patients over 65 years old will have diverticulosis, only a minority experience symptoms. These are often similar to those of irritable bowel syndrome with pain and disordered bowel habit, but differ in having an onset in the sixth to seventh decade. The underlying mechanisms include visceral hypersensitivity which maybe postinflammatory, but may also be due to altered central pain processing. Somatization is a useful clue to a predominantly central pathology, while its absence points to local causes including altered enteric nerves and mucosal immune activation. Treatments should be tailored to the individual patient who shows either predominantly peripheral or central abnormalities.
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Somatic Awareness and Tender Points in a Community Sample. THE JOURNAL OF PAIN 2016; 17:1281-1290. [PMID: 27589911 DOI: 10.1016/j.jpain.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 02/05/2023]
Abstract
Somatic awareness (SA) refers to heightened sensitivity to a variety of physical sensations and symptoms. Few attempts have been made to dissociate the relationship of SA and affective symptoms with pain outcomes. We used a validated measure of mood and anxiety symptoms that includes questions related to SA to predict the number of tender points found on physical examination in a large cross-sectional community sample (the Midlife in the United States [MIDUS] Biomarker study). General distress, positive affect, and SA, which were all significantly associated with tender point number in bivariate analyses, were used as predictors of the number of tender points in a multivariate negative binomial regression model. In this model a greater number of tender points was associated with higher levels of SA (P = .02) but not general distress (P = .13) or positive affect (P = .50). Follow-up mediation analyses indicated that the relationship between general distress and tender points was partially mediated by levels of SA. Our primary finding was that SA is strongly related to the number of tender points in a community sample. Mechanisms linking SA to the spatial distribution of pain sensitivity should be investigated further. PERSPECTIVE This article presents an analysis of 3 overlapping psychological constructs and their relationship to widespread pain sensitivity on palpation. The findings suggest that SA is most strongly related to the spatial distribution of pain sensitivity and that further assessing it may improve our understanding of the relationship between psychological factors and pain.
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