Sigrid Elsenbruch Professor of Experimental Psychobiology & Gender Research, University Hospital of Essen, University of Duisburg-Essen
Neural underpinning of nocebo hyperalgesia in visceral pain
Knowledge from placebo and nocebo research aimed at elucidating the role of treatment expectations and learning experiences in shaping the response to visceral pain fills an important research gap. First, chronic abdominal pain, such as in irritable bowel syndrome (IBS), is highly prevalent, with detrimental individual and socioeconomic impact and limited effective treatment options. At the same time, IBS patients show high placebo response rates in clinical trials and benefit from placebo interventions. Second, psychological factors including negative emotions (e.g., anxiety) and cognitions (e.g., pain-related fear) in the context of visceral pain have been implicated in the pathophysiology of IBS and other conditions characterized by medically-unexplained somatic symptoms. Hence, the study of nocebo effects and underlying neural mechanisms in visceral pain constitutes a model to assess the contribution of psychological factors. Herein, the clinical relevance of visceral pain is introduced with a focus on IBS as a bio-psycho-social disorder, followed by a review of existing clinical and experimental work on nocebo effects in IBS and in clinically-relevant visceral pain models in healthy volunteers. Finally, emerging research trends are highlighted along with an outlook regarding goals for ongoing and future research.
Sigrid Elsenbruch is a Professor of Experimental Psychobiology & Gender Research at the University Hospital of Essen, University of Duisburg-Essen, Germany. Her interdisciplinary research focusses on biological and psychological aspects of the brain-gut axis in human visceral pain, especially in irritable bowel syndrome. She has accomplished several research studies on placebo and nocebo effects in visceral pain, including brain imaging studies to elucidate the neural mechanisms mediating effects of expectations and conditioning in a clinically-relevant model of experimental visceral pain. This research is closely connected to her work on stress and anxiety, providing evidence on the role of emotions and cognitions in the pathophysiology of IBS and other medically-unexplained symptoms involving disturbed interoception.