The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform

Sigrid Elsenbruch - One of the best experts on this subject based on the ideXlab platform.

  • Neural circuitry mediating inflammation-induced central Pain amplification in human experimental endotoxemia.
    Brain behavior and immunity, 2015
    Co-Authors: Sven Benson, Manfred Schedlowski, Michael Forsting, Laura Rebernik, Alexander Wegner, Julian Kleine-borgmann, Harald Engler, Marc Schlamann, Sigrid Elsenbruch
    Abstract:

    Abstract Background & aims: To elucidate the brain mechanisms underlying inflammation-induced visceral hyperalgesia in humans, in this functional magnetic resonance imaging (fMRI) study we tested if intravenous administration of lipopolysaccharide (LPS) involves altered central processing of visceral Pain stimuli. Methods: In this randomized, double-blind, placebo-controlled fMRI study, 26 healthy male subjects received either an intravenous injection of low-dose LPS ( N  = 14, 0.4 ng/kg body weight) or placebo ( N  = 12, control group). Plasma cytokines (TNF-α, IL-6), body temperature, plasma cortisol and mood were assessed at baseline and up to 6 h post-injection. At baseline and 2 h post-injection (test), Rectal Pain thresholds and Painful Rectal distension-induced blood oxygen level-dependent (BOLD) responses in brain regions-of-interest were assessed. To address specificity for visceral Pain, BOLD responses to non-Painful Rectal distensions and Painful somatic stimuli (i.e., punctuate mechanical stimulation) were also analyzed as control stimuli. Results: Compared to the control group, LPS-treated subjects demonstrated significant and transient increases in TNF-α, IL-6, body temperature and cortisol, along with impaired mood. In response to LPS, Rectal Pain thresholds decreased in trend, along with enhanced up-regulation of Rectal Pain-induced BOLD responses within the posterior insula, dorsolateral prefrontal (DLPFC), anterior midcingulate (aMCC) and somatosensory cortices (all FWE-corrected p Conclusions: These findings support that peripheral inflammatory processes affect visceral Pain thresholds and the central processing of sensory-discriminative aspects of visceral Pain.

  • Perceived treatment group affects behavioral and neural responses to visceral Pain in a deceptive placebo study
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2012
    Co-Authors: Vassilios Kotsis, Elke R. Gizewski, Ulrike Bingel, Sven Benson, Manfred Schedlowski, Michael Forsting, Sigrid Elsenbruch
    Abstract:

    Background  To assess effects of perceived treatment (i.e. drug vs placebo) on behavioral and neural responses to Rectal Pain stimuli delivered in a deceptive placebo condition. Methods  This fMRI study analyzed the behavioral and neural responses during expectation-mediated placebo analgesia in a Rectal Pain model. In N = 36 healthy subjects, the blood oxygen level-dependent (BOLD) response during cued anticipation and Painful stimulation was measured after participants were informed that they had a 50% chance of receiving either a potent analgesic drug or an inert substance (i.e., double-blind administration). In reality, all received placebo. We compared responses in subjects who retrospectively indicated that they received the drug and those who believed to have received placebo. Key Results  55.6% (N = 20) of subjects believed that they had received a placebo, whereas 36.1% (N = 13) believed that they had received a potent analgesic drug. Subjects who were uncertain (8.3%, N = 3) were excluded. Rectal Pain-induced discomfort was significantly lower in the perceived drug treatment group (P 

  • How positive and negative expectations shape the experience of visceral Pain: an experimental pilot study in healthy women.
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2012
    Co-Authors: Sigrid Elsenbruch, Manfred Schedlowski, Julia Schmid, M. Bäsler, Elvir Cesko, Sven Benson
    Abstract:

    Background  In order to elucidate placebo and nocebo effects in visceral Pain, we analyzed the effects of positive and negative expectations on Rectal Pain perception, Rectal Pain thresholds, state anxiety and cortisol responses in healthy women. Methods  Painful Rectal distensions were delivered at baseline, following application of an inert substance combined with either positive instructions of Pain relief (placebo group, N = 15), negative instructions of Pain increase (nocebo group, N = 17), or neutral instructions (control, N = 15). Perceived Pain intensity, unpleasantness/aversion and urge-to-defecate, state anxiety and serum cortisol were determined at baseline, immediately following group-specific instructions and on a second study day after the same instructions (test day). Rectal Pain thresholds were determined at baseline and on the test day. Key Results  Whereas perceived Pain intensity was significantly decreased in the placebo group, the nocebo group revealed significantly increased Pain intensity ratings, along with significantly greater anticipatory anxiety on the test day (all P 

  • behavioural and neural correlates of visceral Pain sensitivity in healthy men and women does sex matter
    European Journal of Pain, 2012
    Co-Authors: Sven Benson, Vassilios Kotsis, Christina Rosenberger, Elke R. Gizewski, Ulrike Bingel, Manfred Schedlowski, Michael Forsting, Sigrid Elsenbruch
    Abstract:

    Introduction We assessed sex differences in behavioural and neural responses to Rectal Pain stimuli in healthy subjects. Methods In age- and body mass index-matched healthy subjects (n = 15 men, 15 women), Rectal sensory and Pain thresholds were assessed with a pressure-controlled barostat device. The blood oxygen level-dependent response during cued anticipation and Painful stimulation was measured using functional magnetic resonance imaging (fMRI). Retrospective Pain evaluations were accomplished with visual analogue scales. For fMRI data, region-of-interest (ROI) analyses and additional whole-brain analyses were carried out. Results There were no sex differences in Rectal thresholds or Pain ratings. ROI analyses revealed comparable distension-induced activation of the thalamus, somatosensory cortex, insula and dorsolateral prefrontal cortex (DLPFC). Only in additional whole-brain analyses did we find increased activation in women in DLPFC and middle temporal gyrus during Pain anticipation and in the cerebellum and medial frontal gyrus during Pain. A significant inverse association between Rectal Pain threshold and distension-induced activation in virtually all ROIs was found in women. In men, Pain thresholds and insula activation were positively correlated, as were Pain ratings and anterior cingulate cortex activation. Conclusions Healthy men and women do not differ in behavioural measures of visceral Pain sensitivity. The pattern of neural activation is comparable in the majority of Pain-processing brain regions, although women may differ in the activation of DLPFC which could reflect sex differences in cognitive–emotional Pain regulation. Women with lower Pain thresholds showed greater neural responses, which may be relevant in the pathophysiology of visceral hyperalgesia.

  • Neuroendocrine and blood pressure responses to Rectal distensions in individuals with high and low visceral Pain sensitivity.
    Psychoneuroendocrinology, 2007
    Co-Authors: Sigrid Elsenbruch, Manfred Schedlowski, Sebastian Haag, A. Lucas, N. Riemenschneider, A. Pietsch, Guido Gerken, Cobi Jacoba Johanna Heijnen, Gerald Holtmann
    Abstract:

    Summary Background The mechanisms of interindividual variations in visceral Pain sensitivity remain poorly understood. We characterized the neuroendocrine responses to Rectal distensions in healthy individuals with high vs. low Rectal Pain sensitivity. Methods Rectal sensory and Pain thresholds were determined, and a series of random Painful distensions was carried out. Eighteen subjects were stratified into groups with a low Rectal Pain threshold (“High Sensitivity” group) vs. a high Rectal Pain threshold (“Low Sensitivity” group) by median split, and were compared with regard to adrenocorticotropic hormone (ACTH) and cortisol, cardiovascular, and emotional responses. Results Distensions led to an anticipatory stress response, reflected by elevated baseline anxiety, and increased baseline ACTH and cortisol in both groups. In response to distensions, the “Low Sensitivity” group showed significantly greater ACTH and cortisol concentrations analysis of variance (ANOVA time×group for ACTH: p Conclusions Painful Rectal distensions are associated with a pronounced anticipatory stress response, reflected by elevated anxiety and elevated stress hormones. Individuals with high Rectal Pain sensitivity differ from those with low Pain sensitivity in distension-induced hormonal and blood pressure responses, suggesting that neuroendocrine responses may be relevant to the pathophysiology of visceral hyperalgesia.

Steven D Wexner - One of the best experts on this subject based on the ideXlab platform.

  • Biofeedback therapy in the colon and Rectal practice.
    Applied psychophysiology and biofeedback, 2003
    Co-Authors: José Marcio Neves Jorge, Angelita Habr-gama, Steven D Wexner
    Abstract:

    In coloproctology, biofeedback has been used for more than 20 years to treat patients with fecal incontinence, constipation, and Rectal Pain. It can be performed in a number of conditions with minimal risk and discomfort. However, it does require the presence of some degree of sphincter contraction and Rectal sensitivity. Biofeedback can be time-consuming and demands motivation. The purpose of this paper is to review the indications, methodology, and results of anoRectal biofeedback in the treatment of these disorders. Mean success rates for biofeedback range from 72.3% for fecal incontinence of diverse etiology, 68.5% for constipation attributable to paradoxical puboRectalis syndrome, and 41.2% for idiopathic Rectal Pain. However, criteria to define success vary tremendously among researchers and there is a tendency to indicate biofeedback in a myriad of conditions when other therapeutic options, including surgery, fail or are inappropriate. These factors make comparison of the results difficult and reinforce the need for randomized controlled trials and studies assessing long-term follow-up. In summary, biofeedback is a simple, cost-effective, and morbidity-free technique and remains an attractive option, especially considering the complexity of the functional disorders of the colon, rectum, anus, and pelvic floor.

  • biofeedback for intractable Rectal Pain outcome and predictors of success
    Diseases of The Colon & Rectum, 1997
    Co-Authors: Robert Gilliland, Steve J Heymen, D F Altomare, Dawn Vickers, Steven D Wexner
    Abstract:

    PURPOSE: A number of modalities have been used for the treatment of intractable Rectal Pain, with varying degrees of success. Electromyography (EMG)-based biofeedback therapy has been used in the treatment of this condition during the past six years. MATERIALS AND METHODS: Medical records of 86 patients who completed at least one session of biofeedback for Rectal Pain between February 1989 and August 1995 were retrospectively reviewed. All sessions were one-hour outpatient encounters with a trained biofeedback therapist. There were 31 male and 55 female patients with a median age of 68 (range, 12–96) years. Surgery (19.8 percent) or stress (15.1 percent) were frequently cited as precipitating factors for the development of Rectal Pain. Eleven patients completed only one session of biofeedback and were excluded from further analysis. Of the remaining patients, 28 complained of concomitant constipation. Assessment of the benefit of therapy was based on the patients' subjective reports of the level of symptoms, aided by a linear analog scale. RESULTS: Twenty six patients (34.7 percent) reported an improvement in symptoms. Outcome was not influenced by patients' ages (P= 0.63), duration of symptoms (P= 1.0), or a prior history of surgery (P= 0.14). Alleviation of symptoms was not significantly related to the presence of paradoxical puboRectalis contraction demonstrated on either EMG (P= 1) or defecography (P= 0.12). Importantly, outcome was significantly improved in patients who completed the treatment schedule compared with those who self-discharged (P <0.001). CONCLUSIONS: Although idiopathic Rectal Pain is difficult to treat, EMG-based biofeedback can produce alleviation of symptoms. However, success depends on patients' willingness to pursue a full course of therapy.

  • Biofeedback for intractable Rectal Pain: outcome and predictors of success.
    Diseases of the colon and rectum, 1997
    Co-Authors: Robert Gilliland, D F Altomare, Dawn Vickers, J. Steve Heymen, Steven D Wexner
    Abstract:

    PURPOSE: A number of modalities have been used for the treatment of intractable Rectal Pain, with varying degrees of success. Electromyography (EMG)-based biofeedback therapy has been used in the treatment of this condition during the past six years. MATERIALS AND METHODS: Medical records of 86 patients who completed at least one session of biofeedback for Rectal Pain between February 1989 and August 1995 were retrospectively reviewed. All sessions were one-hour outpatient encounters with a trained biofeedback therapist. There were 31 male and 55 female patients with a median age of 68 (range, 12–96) years. Surgery (19.8 percent) or stress (15.1 percent) were frequently cited as precipitating factors for the development of Rectal Pain. Eleven patients completed only one session of biofeedback and were excluded from further analysis. Of the remaining patients, 28 complained of concomitant constipation. Assessment of the benefit of therapy was based on the patients' subjective reports of the level of symptoms, aided by a linear analog scale. RESULTS: Twenty six patients (34.7 percent) reported an improvement in symptoms. Outcome was not influenced by patients' ages (P= 0.63), duration of symptoms (P= 1.0), or a prior history of surgery (P= 0.14). Alleviation of symptoms was not significantly related to the presence of paradoxical puboRectalis contraction demonstrated on either EMG (P= 1) or defecography (P= 0.12). Importantly, outcome was significantly improved in patients who completed the treatment schedule compared with those who self-discharged (P

  • ColoRectal physiological tests: use or abuse of technology?
    The European journal of surgery = Acta chirurgica, 1994
    Co-Authors: Steven D Wexner, J. M. N. Jorge
    Abstract:

    OBJECTIVE To assess the value of coloRectal physiological tests in patients with functional disorders of defecation. DESIGN Prospective study. SETTING Academic hospital. SUBJECTS 308 consecutive patients. INTERVENTIONS Routine history and physical examination, followed by colonic transit study, and manometry, cinedefecography, electromyography of the anal sphincter, and assessment of terminal motor latency of the pudendal nerve. MAIN OUTCOME MEASURES Number of diagnoses made after physiological tests compared with routine history and examination alone. RESULTS Definitive diagnoses were made after history and physical examination alone in 15/180 (8%) with constipation, 9/80 (11%) with incontinence, and 11/48 (23%) with intractable Rectal Pain. The figures after physiological tests were 135/180 (75%), 53/80 (66%), and 20/48 (42%), respectively. Among the diagnoses made by physiological testing alone were: in patients with constipation, paradoxical puboRectalis contraction (n = 59), colonic inertia (n = 31), rectocele (n = 19), and intussusception (n = 18); in those with incontinence, loss of muscle fiber (n = 21), neuropathy (n = 10), and both (n = 15); and in those with Rectal Pain, neuropathy (n = 6) and paradoxical puboRectalis contraction (n = 3). The numbers of patients that remained undiagnosed in the three groups were 45 (25%), 27 (34%), and 28 (58%), respectively. Treatable conditions were diagnosed by physiological testing in 120/180 patients with constipation (67%) and 44 patients with incontinence (55%). Only 9 patients with Rectal Pain had treatable causes identified by physiologic testing. CONCLUSION The value of coloRectal physiological tests is greatest in patients who present with constipation or incontinence; they are of little value in those with chronic intractable Rectal Pain.

  • Evaluation and treatment of chronic intractable Rectal Pain--a frustrating endeavor.
    Diseases of the colon and rectum, 1993
    Co-Authors: Gow Ching Ger, Steven D Wexner, J. Marcio, N. Jorge, Eleanor Lee, L. Amar Amaranath, Steve Heymen, Juan J. Nogueras, David G. Jagelman
    Abstract:

    A study was undertaken to assess the evaluation and treatment of chronic intractable Rectal Pain. Sixty consecutive patients, 23 males and 37 females with a mean age of 69 (range, 29-87) years and a mean length of symptoms of 4.5 years, were evaluated by questionnaire, office examination, anal manometry, electromyography, cinedefecography, and pudendal nerve study. In all cases, organic abdominopelvic and anoRectal etiologies for the Pain were excluded by extensive radiologic and endoscopic evaluation. All patients had failed conservative and medical therapy. Ninety-five percent of patients had one or more associated factors: constipation or dyschezia (57 percent), prior pelvic surgery (43 percent), prior anal surgery (32 percent), prior spinal surgery (8 percent), irritable bowel syndrome (10 percent), or psychiatric disorders (depression or anxiety; 25 percent). Possible etiologies for the Pain included levator spasm or anismus in 62 percent, coccygodynia in 8 percent, and pudendal neuropathy in 24 percent of patients. Therapy for Pain control included electrogalvanic stimulation (EGS) in 29, biofeedback (BF) in 14, and steroid caudal block (SCB) in 11 patients. Pain control was assessed by an independent observer at a mean of 15 (range, 2-36) months after completion of therapy. Continued successful Pain relief was classified by patients as good or excellent after EGS in 38 percent, after BF in 43 percent, and after SCB in 18 percent; overall success was reported by 47 percent of patients. The presence of levator spasm, coccygodynia, or pudendal neuropathy did not influence outcome. The routine use of physiologic investigation of Rectal Pain may not be justifiable. Moreover, more than half of the patients were refractory to all three therapeutic options used in this study.

Lawrence C. Brilliant - One of the best experts on this subject based on the ideXlab platform.

  • Perianal streptococcal dermatitis.
    American family physician, 2000
    Co-Authors: Lawrence C. Brilliant
    Abstract:

    Perianal streptococcal dermatitis is a bright red, sharply demarcated rash that is caused by group A beta-hemolytic streptococci. Symptoms include perianal rash, itching and Rectal Pain; blood-streaked stools may also be seen in one third of patients. It primarily occurs in children between six months and 10 years of age and is often misdiagnosed and treated inappropriately. A rapid streptococcal test of suspicious areas can confirm the diagnosis. Routine skin culture is an alternative diagnostic aid. Treatment with amoxicillin or penicillin is effective. Follow-up is necessary, because recurrences are common.

Clive H. Wilder-smith - One of the best experts on this subject based on the ideXlab platform.

  • Cortical effects of anticipation and endogenous modulation of visceral Pain assessed by functional brain MRI in irritable bowel syndrome patients and healthy controls.
    Pain, 2006
    Co-Authors: Guang Hui Song, Vinod Venkatraman, Michael W. L. Chee, Khay Guan Yeoh, Clive H. Wilder-smith
    Abstract:

    Visceral Pain processing is abnormal in a majority of irritable bowel syndrome (IBS) patients. Aberrant endogenous nociceptive modulation and anticipation are possible underlying mechanisms investigated in the current study. Twelve IBS patients and 12 matched healthy controls underwent brain fMRI scanning during the following randomised stimuli: sham and Painful Rectal distensions by barostat without and with simultaneous activation of endogenous descending nociceptive inhibition using ice water immersion of the foot for heterotopic stimulation. Heterotopic stimulation decreased Rectal Pain scores from 3.7+/-0.2 to 3.1+/-0.3 (mean+/-SE, scale 0-5) in controls (p

  • Cortical effects of anticipation and endogenous modulation of visceral Pain assessed by functional brain MRI in irritable bowel syndrome patients and healthy controls.
    Pain, 2006
    Co-Authors: Guang Hui Song, Vinod Venkatraman, Michael W. L. Chee, Khay Guan Yeoh, Clive H. Wilder-smith
    Abstract:

    Visceral Pain processing is abnormal in a majority of irritable bowel syndrome (IBS) patients. Aberrant endogenous nociceptive modulation and anticipation are possible underlying mechanisms investigated in the current study. Twelve IBS patients and 12 matched healthy controls underwent brain fMRI scanning during the following randomised stimuli: sham and Painful Rectal distensions by barostat without and with simultaneous activation of endogenous descending nociceptive inhibition using ice water immersion of the foot for heterotopic stimulation. Heterotopic stimulation decreased Rectal Pain scores from 3.7 ± 0.2 to 3.1 ± 0.3 (mean ± SE, scale 0–5) in controls (p < 0.01), but not significantly in IBS. Controls differed from IBS patients in showing significantly greater activation bilaterally in the anterior insula, SII and putamen during Rectal stimulation alone compared to Rectal plus heterotopic stimulation. Greater activation during Rectal plus heterotopic versus Rectal stimulation was seen bilaterally in SI and the right superior temporal gyrus in controls and in the right inferior lobule and bilaterally in the superior temporal gyrus in IBS. Rectal Pain scores were similarly low during sham stimulation in both groups, but brain activation patterns differed. In conclusion, IBS patients showed dysfunctional endogenous inhibition of Pain and concomitant aberrant activation of brain areas involved in Pain processing and integration. Anticipation of Rectal Pain was associated with different brain activation patterns in IBS involving multiple interoceptive, homeostatic, associative and emotional areas, even though Pain scores were similar during sham distension. The aberrant activation of endogenous Pain inhibition appears to involve circuitry relating to anticipation as well as Pain processing itself.

Manfred Schedlowski - One of the best experts on this subject based on the ideXlab platform.

  • Neural circuitry mediating inflammation-induced central Pain amplification in human experimental endotoxemia.
    Brain behavior and immunity, 2015
    Co-Authors: Sven Benson, Manfred Schedlowski, Michael Forsting, Laura Rebernik, Alexander Wegner, Julian Kleine-borgmann, Harald Engler, Marc Schlamann, Sigrid Elsenbruch
    Abstract:

    Abstract Background & aims: To elucidate the brain mechanisms underlying inflammation-induced visceral hyperalgesia in humans, in this functional magnetic resonance imaging (fMRI) study we tested if intravenous administration of lipopolysaccharide (LPS) involves altered central processing of visceral Pain stimuli. Methods: In this randomized, double-blind, placebo-controlled fMRI study, 26 healthy male subjects received either an intravenous injection of low-dose LPS ( N  = 14, 0.4 ng/kg body weight) or placebo ( N  = 12, control group). Plasma cytokines (TNF-α, IL-6), body temperature, plasma cortisol and mood were assessed at baseline and up to 6 h post-injection. At baseline and 2 h post-injection (test), Rectal Pain thresholds and Painful Rectal distension-induced blood oxygen level-dependent (BOLD) responses in brain regions-of-interest were assessed. To address specificity for visceral Pain, BOLD responses to non-Painful Rectal distensions and Painful somatic stimuli (i.e., punctuate mechanical stimulation) were also analyzed as control stimuli. Results: Compared to the control group, LPS-treated subjects demonstrated significant and transient increases in TNF-α, IL-6, body temperature and cortisol, along with impaired mood. In response to LPS, Rectal Pain thresholds decreased in trend, along with enhanced up-regulation of Rectal Pain-induced BOLD responses within the posterior insula, dorsolateral prefrontal (DLPFC), anterior midcingulate (aMCC) and somatosensory cortices (all FWE-corrected p Conclusions: These findings support that peripheral inflammatory processes affect visceral Pain thresholds and the central processing of sensory-discriminative aspects of visceral Pain.

  • Perceived treatment group affects behavioral and neural responses to visceral Pain in a deceptive placebo study
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2012
    Co-Authors: Vassilios Kotsis, Elke R. Gizewski, Ulrike Bingel, Sven Benson, Manfred Schedlowski, Michael Forsting, Sigrid Elsenbruch
    Abstract:

    Background  To assess effects of perceived treatment (i.e. drug vs placebo) on behavioral and neural responses to Rectal Pain stimuli delivered in a deceptive placebo condition. Methods  This fMRI study analyzed the behavioral and neural responses during expectation-mediated placebo analgesia in a Rectal Pain model. In N = 36 healthy subjects, the blood oxygen level-dependent (BOLD) response during cued anticipation and Painful stimulation was measured after participants were informed that they had a 50% chance of receiving either a potent analgesic drug or an inert substance (i.e., double-blind administration). In reality, all received placebo. We compared responses in subjects who retrospectively indicated that they received the drug and those who believed to have received placebo. Key Results  55.6% (N = 20) of subjects believed that they had received a placebo, whereas 36.1% (N = 13) believed that they had received a potent analgesic drug. Subjects who were uncertain (8.3%, N = 3) were excluded. Rectal Pain-induced discomfort was significantly lower in the perceived drug treatment group (P 

  • How positive and negative expectations shape the experience of visceral Pain: an experimental pilot study in healthy women.
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2012
    Co-Authors: Sigrid Elsenbruch, Manfred Schedlowski, Julia Schmid, M. Bäsler, Elvir Cesko, Sven Benson
    Abstract:

    Background  In order to elucidate placebo and nocebo effects in visceral Pain, we analyzed the effects of positive and negative expectations on Rectal Pain perception, Rectal Pain thresholds, state anxiety and cortisol responses in healthy women. Methods  Painful Rectal distensions were delivered at baseline, following application of an inert substance combined with either positive instructions of Pain relief (placebo group, N = 15), negative instructions of Pain increase (nocebo group, N = 17), or neutral instructions (control, N = 15). Perceived Pain intensity, unpleasantness/aversion and urge-to-defecate, state anxiety and serum cortisol were determined at baseline, immediately following group-specific instructions and on a second study day after the same instructions (test day). Rectal Pain thresholds were determined at baseline and on the test day. Key Results  Whereas perceived Pain intensity was significantly decreased in the placebo group, the nocebo group revealed significantly increased Pain intensity ratings, along with significantly greater anticipatory anxiety on the test day (all P 

  • behavioural and neural correlates of visceral Pain sensitivity in healthy men and women does sex matter
    European Journal of Pain, 2012
    Co-Authors: Sven Benson, Vassilios Kotsis, Christina Rosenberger, Elke R. Gizewski, Ulrike Bingel, Manfred Schedlowski, Michael Forsting, Sigrid Elsenbruch
    Abstract:

    Introduction We assessed sex differences in behavioural and neural responses to Rectal Pain stimuli in healthy subjects. Methods In age- and body mass index-matched healthy subjects (n = 15 men, 15 women), Rectal sensory and Pain thresholds were assessed with a pressure-controlled barostat device. The blood oxygen level-dependent response during cued anticipation and Painful stimulation was measured using functional magnetic resonance imaging (fMRI). Retrospective Pain evaluations were accomplished with visual analogue scales. For fMRI data, region-of-interest (ROI) analyses and additional whole-brain analyses were carried out. Results There were no sex differences in Rectal thresholds or Pain ratings. ROI analyses revealed comparable distension-induced activation of the thalamus, somatosensory cortex, insula and dorsolateral prefrontal cortex (DLPFC). Only in additional whole-brain analyses did we find increased activation in women in DLPFC and middle temporal gyrus during Pain anticipation and in the cerebellum and medial frontal gyrus during Pain. A significant inverse association between Rectal Pain threshold and distension-induced activation in virtually all ROIs was found in women. In men, Pain thresholds and insula activation were positively correlated, as were Pain ratings and anterior cingulate cortex activation. Conclusions Healthy men and women do not differ in behavioural measures of visceral Pain sensitivity. The pattern of neural activation is comparable in the majority of Pain-processing brain regions, although women may differ in the activation of DLPFC which could reflect sex differences in cognitive–emotional Pain regulation. Women with lower Pain thresholds showed greater neural responses, which may be relevant in the pathophysiology of visceral hyperalgesia.

  • Neuroendocrine and blood pressure responses to Rectal distensions in individuals with high and low visceral Pain sensitivity.
    Psychoneuroendocrinology, 2007
    Co-Authors: Sigrid Elsenbruch, Manfred Schedlowski, Sebastian Haag, A. Lucas, N. Riemenschneider, A. Pietsch, Guido Gerken, Cobi Jacoba Johanna Heijnen, Gerald Holtmann
    Abstract:

    Summary Background The mechanisms of interindividual variations in visceral Pain sensitivity remain poorly understood. We characterized the neuroendocrine responses to Rectal distensions in healthy individuals with high vs. low Rectal Pain sensitivity. Methods Rectal sensory and Pain thresholds were determined, and a series of random Painful distensions was carried out. Eighteen subjects were stratified into groups with a low Rectal Pain threshold (“High Sensitivity” group) vs. a high Rectal Pain threshold (“Low Sensitivity” group) by median split, and were compared with regard to adrenocorticotropic hormone (ACTH) and cortisol, cardiovascular, and emotional responses. Results Distensions led to an anticipatory stress response, reflected by elevated baseline anxiety, and increased baseline ACTH and cortisol in both groups. In response to distensions, the “Low Sensitivity” group showed significantly greater ACTH and cortisol concentrations analysis of variance (ANOVA time×group for ACTH: p Conclusions Painful Rectal distensions are associated with a pronounced anticipatory stress response, reflected by elevated anxiety and elevated stress hormones. Individuals with high Rectal Pain sensitivity differ from those with low Pain sensitivity in distension-induced hormonal and blood pressure responses, suggesting that neuroendocrine responses may be relevant to the pathophysiology of visceral hyperalgesia.