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Psychobiologische Mechanismen bei der Pathophysiologie chronischer viszeraler Schmerzen

Psychobiological mechanisms in the pathophysiology of chronic visceral pain

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Zusammenfassung

Viszerale Schmerzen haben eine hohe klinische Relevanz, sind jedoch im Vergleich zu somatischen Schmerzen weniger gut untersucht. Dennoch konnten mithilfe interdisziplinärer Forschungsansätze an der Schnittstelle zwischen Psychophysiologie und Neurogastroenterologie in den letzten Jahren erhebliche Fortschritte in Bezug auf das Verständnis peripherer als auch zentralnervöser Mechanismen der Gehirn-Darm-Achse, die bidirektional ist, erzielt werden. Dieser Übersichtsartikel fasst den Kenntnisstand zu psychobiologischen Mechanismen bei der Pathophysiologie chronischer viszeraler Schmerzen bei funktionellen Magen-Darm-Erkrankungen zusammen. Besonderes Augenmerk gilt dabei den Auswirkung von Affektstörungen sowie Emotionen (u. a. Stress) und Kognitionen auf viszerale sensorische und motorische Prozesse. Neue Erkenntnisse, insbesondere aus der Placeboforschung sowie aus Forschungsansätzen zur schmerzassoziierten Furchtkonditionierung und Extinktion, eröffnen Wege für neue Therapieansätze bei der Behandlung chronischer viszeraler Schmerzen z. B. für Patienten mit Reizdarmsyndrom.

Abstract

Although visceral pain is of high clinical relevance, it remains poorly understood especially when compared to somatic pain. Nevertheless, interdisciplinary research approaches bridging psychophysiology and neurogastroenterology have contributed to a more refined knowledge about the complex peripheral and central mechanisms of the bidirectional brain-gut axis in recent years. This review summarizes current knowledge regarding psychobiological mechanisms in the pathophysiology of chronic visceral pain in functional gastrointestinal disorders with a focus on irritable bowel syndrome (IBS). Special attention is paid to the role of affective disturbances and emotions, particularly psychological stress as well as to influences of cognition and learning on gastrointestinal motor and sensory functions in healthy individuals and patients with IBS. In this emerging field of research, new evidence from the fields of placebo research and pain-related fear conditioning provide new insights into the psychological and neurobiological mechanisms involved in the transition from acute to chronic pain and the maintenance of pain. This opens up new perspectives for innovative treatment approaches for IBS and other functional gastrointestinal disorders.

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Authors and Affiliations

  1. Institut für Medizinische Psychologie und Verhaltensimmunbiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    S. Elsenbruch

  2. Klinik für Innere Medizin VI, Psychosomatische Medizin und Psychologie, Universitätsklinikum Tübingen, Tübingen, Deutschland

    P. Enck

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Correspondence to S. Elsenbruch.

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Interessenkonflikt

S. Elsenbruch und P. Enck geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Elsenbruch, S., Enck, P. Psychobiologische Mechanismen bei der Pathophysiologie chronischer viszeraler Schmerzen. Schmerz 30, 407–411 (2016). https://doi.org/10.1007/s00482-016-0130-9

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  • DOI: https://doi.org/10.1007/s00482-016-0130-9

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