Starts:

Thursday, September 22nd
4:30pm-6:00pm EDT

Category:

Topical Workshop

Tracks:

Specific Pain Conditions/Pain in Specific Populations

Room

713 B

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From Gut Feelings to Memories of Visceral Pain: Mechanisms and Clinical Perspectives for Disorders of Gut-Brain Interactions

Visceral pain is an important yet often underestimated clinical and societal problem. From a clinical perspective, visceral pain is highly prevalent, causes enormous suffering and significant healthcare expenditures. Effective treatment is notoriously difficult, owing at least in part to its complex etiology involving the gut-brain axis. Visceral pain is highly modifiable by psychological factors, and centrally encoded in overlapping brain circuits associated with pain, emotion regulation and stress. The mechanisms and specificity to the visceral modality, however, remain incompletely understood. Pain-related learning and memory processes underlying hyperalgesia and hypervigilance may be shaped by the unique salience of visceral pain. New evidence on the putative role of impaired extinction learning calls for an extension of the fear avoidance model and provides new avenues for treatment. Applying cognitive-behavioral principles including exposure could benefit many patients with disturbed interoception. The newly evolving area of “psychogastroenterology” at the interface the pain field, psychology, the neurosciences and gastroenterology is fascinating for a cross-disciplinary audience and can teach us about how the “little brain in the gut” shapes normal behavior as well as symptom perception along the gut-brain axis.

Presentations

Time
4:30pm EDT–6:00pm EDT

Applying What We Know: Conceptualization and Intervention of Visceral Pain through a Cognitive-behavioral Lense

Tracks: Specific Pain Conditions/Pain In Specific Populations
Categories: Topical Workshop
Presented By: Dr. Livia A. Guadagnoli

Psychological processes can influence symptom experience in gastrointestinal (GI) disorders, where visceral pain is a predominant symptom. Attempts to protect oneself from pain can trigger maladaptive cognitive-affective and behavioral processes, such as hypervigilance, visceral anxiety, and avoidance behaviors. These responses are reinforced when symptoms decrease in the short-term, resulting in long-term adverse consequences. Given the role of gut-brain dysregulation in symptom etiology, research has historically focused on disorders of gut-brain interaction (irritable bowel syndrome, functional heartburn). However, principles of classical conditioning and fear-learning are increasingly implicated as mechanisms of visceral pain perception and modulation across the GI spectrum, including organic disease. Given the modifiable nature of these processes, behavioral intervention has proven effective in decoupling learned associations and teaching effective skills. Consistent with a cognitive-behavioral framework, treatment focuses on psychoeducation about the gut-brain axis, skills-training in relaxation and adaptive coping, restructuring unhelpful thinking patterns, and behavioral exposure. This talk will review the translational aspects of visceral pain perception and modulation, specifically focusing on conceptualizing a patient’s symptom experience through a biopsychosocial lens and applying brain-gut behavioral therapy to the GI patient population.

4:30pm EDT–6:00pm EDT

From Pavlov to Pain: Associative Learning and Extinction of Visceral Pain-related Fear in Health and Patients with Chronic Visceral Pain

Tracks: Specific Pain Conditions/Pain In Specific Populations
Categories: Topical Workshop
Presented By: Professor Sigrid Elsenbruch

The importance of pain-related learning and memory processes in the pathophysiology and treatment of chronic pain is increasingly recognized. This is not only based on growing evidence that learning and extinction are altered in different pain conditions. It is also conceptually driven by the unique biological salience of pain, which may be especially pronounced for visceral pain. Associative learning and extinction, as studied using Pavlovian fear conditioning as a translational model in the neurosciences, represent fundamental adaptive responses aimed at self-protection. Conditioned pain-related fear is an essential component of this response. In patients with chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to hypervigilance and hyperalgesia. However, visceral pain-related extinction processes and their underlying neural circuitry remain uncharted research territory. This talk will address behavioral and neural mechanisms of visceral pain-related extinction learning in healthy volunteers and patients with irritable bowel syndrome. New data suggesting preferential learning for the visceral modality and impaired extinction of maladaptive visceral pain-related fear and safety responses call for an extension of the fear-avoidance model of pain. The idea of “interoceptive conditioning” will be introduced, along with innovative experimental paradigms modelling different aspects of the clinical reality of patients.

4:30pm EDT–6:00pm EDT

Neurobiology of Visceral Pain Disorders as Biopsychosocial Disorders of Gut-brain Interaction

Tracks: Specific Pain Conditions/Pain In Specific Populations
Categories: Topical Workshop
Presented By: Lukas Van Oudenhove

Visceral pain is a core symptom of functional gastrointestinal disorders (FGID), including irritable bowel syndrome and functional dyspepsia-epigastric pain syndrome. Despite their high prevalence, FGID remain poorly understood, therefore treatment remains challenging. The Rome IV expert consensus recently redefined FGID as disorders of gut-brain interaction, acknowledging the central role of the gut-brain axis in etiology and pathogenesis. The gut-brain axis is a complex bidirectional neurohumoral communication system between the gastrointestinal tract and the brain constituting the (neuro)biological basis for the biopsychosocial model of FGID. (Symptom-specific) psychological distress are common in these disorders, highlighting the important role of psychological factors as initiating, exacerbating, and/or perpetuating factors. A frequent feature of FGID is increased perceptual sensitivity to experimentally induced noxious visceral stimulation, referred to as visceral hypersensitivity. Although its underlying mechanisms are incompletely understood and may differ between patients, recent efforts have increased our understanding of peripheral and central neural mechanisms of visceral pain processing and its modulation by psychological processes including (symptom-specific) fear and anxiety, which may in turn be initiated and perpetuated by pain-related learning and memory processes. Specificity of these mechanisms for visceral versus somatic pain remains understudied, but recent studies have shed new light on this question.

Presenters

Lukas Van Oudenhove

KU Leuven

Professor Sigrid Elsenbruch

Head of Department
Ruhr University Bochum, Faculty of Medicine

Dr. Livia A. Guadagnoli

Postdoctoral Researcher
KU Leuven