Studies/Reviews of hypnotherapy for Irritable Bowel Syndrome

LINK Background & Aims: Rectal pain sensitivity has been called a biological marker for irritable bowel syndrome, but this conclusion may be premature. This article is a critical review of the evidence for psychological influences on perception. Methods: The world literature accessible through Index Medicus from 1973 to 1997 was systematically reviewed. Results: Evidence favoring a biological basis for pain sensitivity is that two thirds of patients report pain at abnormally low thresholds of rectal distention despite normal somatic pain thresholds. Pain thresholds are not correlated with anxiety or depression. Evidence favoring psychological influences on perception is that patients with the irritable bowel syndrome rate even sham distentions as more painful, and when perception tests that minimize psychological influences are used, they have normal sensory thresholds. Also, stress alters sensory thresholds. Sensitization by repeated distention has been cited as evidence of a biological basis for hyperalgesia, but it is not unique to patients with irritable bowel. Brain imaging shows that different regions are activated by painful distention in patients with irritable bowel syndrome, but this is consistent with psychological influences on perception. Conclusions: Psychological factors influence pain thresholds in patients with the irritable bowel syndrome. Two cognitive traits, selective attention to gastrointestinal sensations and disease attribution, may account for increased pain sensitivity selective attention to gastrointestinal sensations and disease attribution, may account for increased pain sensitivity Gastroenterology International – Vol 11 No 1 pp 36-44 1998 Physiological and psychological aspects of irritable bowel syndrome and the role of hypnosis W. M. Gonsalkorale, L.A Houghton, P. J. Whorwell Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK DOWNLOAD PDF Over the years, irritable bowel syndrome has largety been considered as either a psychological or motility disorder. More recently, the concept that visceral sensitivity may be abnormal has become fashionable although there is still much debate over whether this is manifested at the gut level or located more centrally in the nervous system. Obviously, until the pathogenesis of irritable bowel syndrome is better understood, the rational development of appropriate pharmacological approaches to treatment is going to be hampered. Approximately 15_years ago, we formulated the hypothesis that as long as irritable bowel syndrome results from a potentially reversible rather than irreversible dysfunction of physiological control mechanisms, then it may respond favorably to an approach aimed at encouraging the body to restore itself to normal. Hypnotherapy is such an approach and has the advantage of not being necessarily dependent on a complete understanding of the pathophysiological mechanisms involved. This paper reviews some of our work in this field and how we have tried to also examine the effect of hypnosis on various pathogenetic mechanisms as they have become topical.