Pain and psyche in a patient with irritable bowel syndrome: chicken or egg? A time series case report

Sex Differences in Visceral Pain and Comorbidities: Clinical Outcomes, Preclinical Models, and Cellular and Molecular Mechanisms

Sexual dimorphism of visceral pain has been documented in clinics and experimental animal models. Aside from hormones, emerging evidence suggests the sex-differential intrinsic neural regulation of pain generation and maintenance. According to the International Association for the Study of Pain (IASP) and the American College of Gastroenterology (ACG), up to 25% of the population have visceral pain at any one time, and in the United States 10-15 percent of adults suffer from irritable bowel syndrome (IBS). Here we examine the preclinical and clinical evidence of sex differences in visceral pain focusing on IBS, other forms of bowel dysfunction and IBS-associated comorbidities. We summarize preclinical animal models that provide a means to investigate the underlying molecular mechanisms in the sexual dimorphism of visceral pain. Neurons and nonneuronal cells (glia and immune cells) in the peripheral and central nervous systems, and the communication of gut microbiota and neural systems all contribute to sex-dependent nociception and nociplasticity in visceral painful signal processing. Emotion is another factor in pain perception and appears to have sexual dimorphism.

Assessment of psychological alarms and coping strategies of medical students with irritable bowel syndrome at Zagazig University: A cross-sectional study

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. Medical students tend to report a higher prevalence of IBS since they are under constant stress. Many psychological difficulties are associated with IBS. To cope with IBS, individuals use various strategies which can impact the intensification or alleviation of IBS symptoms. The objective of this study was to assess the prevalence of IBS in medical students as well as psychological alarms and coping strategie employed by IBS sufferers.

MATERIALS AND METHODS

We conducted a cross-sectional study from December 2022 to February 2023. Study participants were first to fifth year medical school students at Zagazig University, Egypt. Data were collected using a structured questionnaire comprising four sections: sociodemographic and clinical data; Rome IV criteria for the diagnosis of IBS; the alarm questionnaire for functional gastrointestinal disorders; and the Coping Strategies Questionnaire (CSQ24). Chi-square test or Fischer's exact test, as appropriate, were used to test for association. Binary logistic regression with a backward stepwise method was used to determine significant risk factors of negative coping with IBS.

RESULTS

Of the studied 221 medical students, 38% had IBS. A statistically significant association was observed between IBS and the feeling of tension, anxiety, nervousness, depression, and frustration in the previous week, severe pain in the past 4 weeks, and the feeling that the bad situation would not get any better. Most of the students in the IBS group coped positively with stress, while 19.0% were negative in coping. Pain affecting the daily activities and the feelings of depression and frustration to the point of self-harm or suicide were the most significant correlates of IBS group's inability to cope.

CONCLUSION

The prevalence of IBS in medical students at Zagazig University was 38%. We recommend psychological intervention and stress management programs to help medical students cope with IBS.

Temporal Relationships Between Abdominal Pain, Psychological Distress and Coping in Patients With IBS - A Time Series Approach

OBJECTIVE

Irritable bowel syndrome (IBS) is a chronic disease leading to abdominal pain that is often related to psychological distress. The aim of the study was to investigate the temporal relationships between abdominal pain and psychological variables in patients with IBS.

METHODS

This longitudinal diary study included eight patients from a waiting group, recruited in the frame of a pilot intervention study. During their waiting time of 3 months the patients answered questions daily regarding somatic and psychological variables using an online diary. All patients were considered and analyzed as single cases. The temporal dynamics between the time series of psycho-somatic variables were analyzed using a vector autoregressive (VAR) modeling approach.

RESULTS

For all patients, positive same-day correlations between somatic and psychological time series were observed. The highest same-day correlations were found between somatic symptoms and pain-related discomfort (r = 0.40 to r = 0.94). Altogether, n = 26 significant lagged relationships were identified; n = 17 (65%) indicated that somatic values were predictive of psychological complaints on the following days. N = 9 (35%) lagged relationships indicated an opposite relationship in that psychological complaints were predictive of somatic symptoms. Three patients showed a significant positive same-day correlation between abdominal pain and use of a positive coping strategy. However, significant lagged relationships in two patients showed that for these patients the use of positive thinking as a coping strategy was unhelpful in reducing pain on the following days.

CONCLUSIONS

In patients with IBS abdominal symptoms appear to be closely related to psychological symptoms. For some patients, somatic complaints predict psychological complaints, in other patients the directionality is opposite. The impact of coping strategies on somatic symptoms varies among patients, therefore their role for a possible reduction of pain should be further explored. The results suggest the need of characterizing patientsindividually for effective health interventions. Individual time series analyses provide helpful tools for finding reasonable person-level moderators.