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Discussion Starter · #1 ·
I have been doing some research on pain and found out some interesting things. I was wondering what for the most part people's perception of pain and ibs stems from, as I think its important to understand pain and IBS.I know I spent many years telling my doctors to find a reason why I was in so much pain. I personally felt there had to be a structural reason for it as it was so severe. So,I think it is a good thing to talk about and try to figure out together.I will post some info, but first I wanted to see what people's thoughts were. ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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At the risk of offending everyone with my nerve/brain-gut axis thing.There are a number of conditions where the pain is definitely cause by the nerves and the brain reacting funny. For example, people with amputated limbs sometimes have severe pain from the limb that is not there.Lesions on the brain and on the spinal cord can cause severe pain for no really good reason other than the nerves are doing it. I saw the author of this book on Montel http://www.amazon.com/exec/obidos/ASIN/006...3904169-8022136 She has a disease that caused a lesion on her spinal cord. It takes her something like 200 grains of morphine just to put her coat on to go out of the house. I haven't gotten the book, yet, but it looked really good and really inspirational for how to have a life and how to have a chonic debilitating illness at the same time. FWIW, alot of the pain I had in my colon in many respects mirrored the pain that I got when the severed nerve in my finger healed. Severe pain at the smallest of stimuli. I hadn't thought about this in quite this way before, but with my finger I could see when I was brushing lightly against something and when I was slamming it with a sledgehammer. For a couple of days everything felt like the sledge hammer. With my gut I couldn't see what was going on, so I couldn't correct for the incorrect perceptions (perhaps, if you believe that the studies that show that inflamation can depopulate the gut wall ganglion actually showed that, which I do..and it appears that my IBS occured after some sort of infection and inflammatory process, so it is logical that there could be nerves that were damaged and needed to be healed). Perhaps what some of the CBT allowed me to do was tell my intestinal nerves that the sledge hammer wasn't there and allowed the nerves to get used to normal stimuli. New nerves don't know the difference and tend to respond full force to everything, and it takes interacting with the brain and/or central nervous system before they learn.Anywho...that's my thoughts at this time.K.
 

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Eric, Interesting and timely topic for me. I doubt I'll be much help though. You see I'm just realizing or accepting?? and admitting(OutLoud that is) that I have pain. I'm one of those people that don't want to complain, trouble others(Like Dr.s), with pain. I've been told that I'm extremely "stoic" by nurses, Drs. Etc. I have pain, as it turns out, often. I think somewhere (probably deep in my psyche or some other pycho-place) I learned that talking about pain or admitting I have or (stupidly enough) admit to myself that I have pain is some kind of weakness of character. I KNOW this is not true. But I guess I KNOW it well in my head and haven't got it yet in my heart(or gut). I'm working on it, but like I said I'm just starting to get into this. I didn't articulate my pain well enough to avoid having emergency gall bladder surgery. I don't blame the Dr. for "missing" the diagnosis. How could he make an accurate assessment of my condition when I did not communicate the symptom of pain accurately? I blame myself. So, I'm interested to see what kind of responses you get and I'm hoping to learn some more to get me on my way to accepting and accurately describing pain. Thanks for the post and any info you can pass on. Thanks. BQ
 

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Discussion Starter · #4 ·
I was just about to delete what I said, because I didn't want it taken wrong.However, your two posts are a very good start and K, I am glad your here to help.
Also, I still owe you an email and its coming so you know I haven't forgotten you. Good Post K.BQ, your post took me by surprize really, I have use to scream to my doc's I was in pain, although they could tell when I couldn't stand up in there office a few times.It is important to try to explain the pain to your doctor so he understands. BQ, we will try to help here for sure. BQ, I commend you for being brave and speaking up about this and I can tell you that it took strenght I am sure for you to say this, and some of managing IBS is admitting some of our own weeknesses.I think understanding the nature of pain from IBS is important. The pain is not eminating from a wound so to speak, where the nerves are sending localized signals to the brain, as they cannot find anything injured or inflammed in IBS.We are more sensitive in our guts for sure and some of this has to do with the nerves in that location as well. We can go more in to this.There are some interesting articles here on pain that are worth reading, some are technical in a way though, but good reading.Go to http://www.findarticles.com/PI/index.jhtml and type in pain. You will also find some interesting articles by typing in IBS here.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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Discussion Starter · #5 ·
I want to add this here as well. A pretty good summary of IBS.Irritable Bowel Syndrome What is an Irritable Bowel? Medically, irritable bowel syndrome (IBS) is known by a variety of other terms: spastic colon, spastic colitis, mucous colitis and nervous or functional bowel. Usually, it is a disorder of the large intestine (colon), although other parts of the intestinal tract -- even up to the stomach -- can be affected. The colon, the last five feet of the intestine, serves two functions in the body. First, it dehydrates and stores the stool so that, normally, a well-formed soft stool occurs. Second, it quietly propels the stool from the right side over to the rectum, storing it there until it can be evacuated. This movement occurs by rhythmic contractions of the colon. When IBS occurs, the colon does not contract normally. instead, it seems to contract in a disorganized, at times violent, manner. The contractions may be terribly exaggerated and sustained, lasting for prolonged periods of time. One area of the colon may contract with no regard to another. At other times, there may be little bowel activity at all. These abnormal contractions result in changing bowel patterns with constipation being most common. A second major feature of IBS is abdominal discomfort or pain. This may move around the abdomen rather than remain localized in one area. These disorganized, exaggerated and painful contractions lead to certain problems. The pattern of bowel movements is often altered. Diarrhea may occur, especially after meals, as the entire colon contracts and moves liquid stool quickly into the rectum. Or, localized areas of the colon may remain contracted for a prolonged time. When this occurs, which often happens in the section of colon just above the rectum, the stool may be retained for a prolonged period and be squeezed into small pellets. Excessive water is removed from the stool and it becomes hard. Also, air may accumulate behind these localized contractions, causing the bowel to swell. So bloating and abdominal distress may occur. Some patients see gobs of mucous in the stool and become concerned. Mucous is a normal secretion of the bowel, although most of the time it cannot be seen. IBS patients sometimes produce large amounts of mucous, but this is not a serious problem. The cause of most IBS symptoms -- diarrhea, constipation, bloating, and abdominal pain -- are due to this abnormal physiology. IBS is not a disease Although the symptoms of IBS may be severe, the disorder itself is not a serious one. There is no actual disease present in the colon. In fact, an operation performed on the abdomen would reveal a perfectly normal appearing bowel. Rather, it is a problem of abnormal function. The condition usually begins in young people, usually below 40 and often in the teens. The symptoms may wax and wane, being particularly severe at some times and absent at others. Over the years, the symptoms tend to become less intense. IBS is extremely common and is present in perhaps half the patients that see a specialist in gastroenterology. It tends to run in families. The disorder does not lead to cancer. Prolonged contractions of the colon, however, may lead to diverticulosis, a disorder in which balloon-like pockets push out from the bowel wall because of excessive, prolonged contractions. Causes While our knowledge is still incomplete about the function and malfunction of the large bowel, some facts are well-known. Certain foods, such as coffee, alcohol, spices, raw fruits, vegetables, and even milk, can cause the colon to malfunction. In these instances avoidance of these substances is the simplest treatment. Infections, illnesses and even changes in the weather somehow can be associated with a flare-up in symptoms. So can the premenstrual cycle in the female. By far, the most common factor associated with the symptoms of IBS are the interactions between the brain and the gut. The bowel has a rich supply of nerves that are in communication with the brain. Virtually everyone has had, at one time or another, some alteration in bowel function when under intense stress, such as before an important athletic event, school examination, or a family conflict. People with IBS seem to have an overly sensitive bowel, and perhaps a super abundance of nerve impulses flowing to the gut, so that the ordinary stresses and strains of living somehow result in colon malfunction. These exaggerated contractions can be demonstrated experimentally by placing pressure- sensing devices in the colon. Even at rest, with no obvious stress, the pressures tend to be higher than normal. With the routine interactions of daily living, these pressures tend to rise dramatically. When an emotionally charged situation is discussed, they can reach extreme levels not attained in people without IBS. These symptoms are due to real physiologic changes in the gut -- a gut that tends to be inherently overly sensitive, and one that overreacts to the stresses and strains of ordinary living. Diagnosis The diagnosis of IBS often can be suspected just by a review of the patient's medical history. In the end it is a diagnosis of exclusion; that is, other conditions of the bowel need to be ruled out before a firm diagnosis of IBS can be made. A number of diseases of the gut, such as inflammation, cancer, and infection, can mimic some or all of the IBS symptoms. Certain medical tests are helpful in making this diagnosis, including blood, urine and stool exams, x-rays of the intestinal tract and a lighted tube exam of the lower intestine. This exam is called endoscopy, sigmoidoscopy or colonoscopy. Additional tests often are required depending on the specific circumstances in each case. If the proper medical history is obtained and if other diseases are ruled out, a firm diagnosis of IBS then can usually be made. Treatment The treatment of IBS is directed to both the gut and the psyche. The diet requires review, with those foods that aggravate symptoms being avoided. Current medical thinking about diet has changed a great deal in recent years. There is good evidence to suggest that, where tolerated, a high roughage and bran diet is helpful. This diet can result in larger, softer stools which seem to reduce the pressures generated in the colon. Large amounts of beneficial fiber can be obtained by taking over-the-counter bulking agents such as psyllium mucilloid (Metamucil, Konsyl) or methylcellulose (Citrucel). As many people have already discovered, the simple act of eating may, at times, activate the colon. This action is a normal reflex, although in IBS patients it tends to be exaggerated. It is sometimes helpful to eat smaller, more frequent meals to block this reflex. There are certain medications that help the colon by relaxing the muscles in the wall of the colon, thereby reducing the bowel pressure. These drugs are called antispasmodics. Since stress and anxiety may play a role in these symptoms, it can at times be helpful to use a mild sedative, often in combination with an antispasmodic. A newer drug called Lotronex (generic: alosetron) is helpful for IBS patients that have diarrhea as a predominant symptom. Physical exercise, too, is helpful. During exercise, the bowel typically quiets down. If exercise is used regularly and if physical fitness or conditioning develops, the bowel may tend to relax even during non-exercise periods. The invigorating effects of conditioning, of course, extend far beyond the intestine and can be recommended for general health maintenance. As important as anything else in controlling IBS is learning stress reduction, or at least how to control the body's response to stress. It certainly is well-known that the brain can exert controlling effects over many organs in the body, including the intestine. Summary Patients with IBS can be assured that nothing serious is wrong with the bowel. Prevention and treatment may involve a simple change in certain daily habits, reduction of stressful situations, eating better and exercising regularly. Perhaps the most important aspect of treatment is reassurance. For most patients, just knowing that there is nothing seriously wrong is the best treatment of all, especially if they can learn to deal with their symptoms on their own. ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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Interesting that this topic came today...been to the docs on Friday and again today for pain..she (the doc)and I discussed chronic pain. For medical science, the docscan put tissue, the intestines, or whatever,under the microscope, examine it,and see nothing there, for example, we know the uterus is in pain after childbirth, but there is nothing "wrong" with it...but there is pain...So another round of tests for me, and also the possible reality of the going to a pain clinic..(this is different than my IBS pain, btw) when I mentioned what I am doing for my IBS pain (tapes) she was impressed...it is all about living with pain that cannot be addressed with meds, etc. And it comes down again to what was mentioned above in the mind-gut or even mind-body connection, when there is not an obvious measureable condition. I have had times in the past where I was laying on the back seat of the car while someone rushes me to the doc...I had my bags packed fully expecting to be admitted for a bone fide condition...not so...pain and living with it on a constant day-to-day basis is a challenge to the psyche (depression causing) and to your quality of life. (Just so you guys know...I have had surgery on my foot, and await another surgery for the other one, as well as other pain I deal with in addition to the IBS, which is actually better).....The posts above are very insightful...thanks for sharing.. ------------------Marilyn
 

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Pain is somewhat difficult to evaluate as it depends on an individual's ability to tolerate it.For example, childbirth is painful - some handle it well, other don't. Is this tolerance or degree of pain? I know I have a tolerance for the internal "can't touch it" kind of pain yet skin abrasions send me through the roof. The only time I have ever gone to Emergency (for myself) was for pain that turned out to be a kidney stone - but I passed the stone without any medication (waited so long for treatment that I passed it in the ER). The nurses kept saying how strong I was cause the pain from kidney stones was supposed to be really bad. But to me it didn't seem much worse than what I had daily with my IBS. Maybe you just get used to it and find ways to make it bearable. I was just realizing on the weekend that my pain level is greatly diminished from what it used to be. I don't get the really bad cramps anymore and they rarely linger after an attack is over like they used to. Yeah!
 

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Eric, Thanks for your supportive words. I have, perhaps a stupid, question. What causes the intestinal contractions to occur? Is there a particular chemical that tells them to contract? Like in someone who doesn't have Ibs, what's going Right for them but wrong for us? Is there a chemical or something that tells the nerves to respond but in us our nerves don't know when to quit, or in C-types, when to get started? The description of IBS was one of the best, in the vernacular descriptions, I've ever read, BTW, thanks. I'm down an organ, so I'm not the sharpest tool in the shed, if you know what I mean. So I get easily lost & confused and quickly turn into the "Dave's not here" guy from Cheech & Chong with alot of technical stuff, so I appreciate any layman's terms you could use. Thanks yet again! BQ
 

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Hey BQ, I don't think we've got a full picture of how the nerves do different things in IBSers and "normals" but then again I don't think we fully understand "normal" digestion and how it is controlled by the nerves to begin with. At least this part of what we know makes some sense. There appear to be sets of nerves that work kinda like litte computer programs for a local area, and then there is another few levels above the local circuits that coordinate the activity between the local circuits. Problems could occur at several levels. The circuit may not be responding properly to the conrolling nerves instructions. So if the contoller says mild contraction like is often done in a wave down the colon to move stuff along. the circuit goes OK, and squeezes as tightly as possible (spasm), or doesn't squeeze at the right times making things not progress as smoothly as one would want.There could be a problem at one of the controller levels, so the local circuits aren't getting the right information. They are behaving as they are told, but the instructions are wrong. The controll levels include ones in the brain. One way the brain can influence the gut circuits (the he got so scared he pooped in his pants response--and may be in part resposable for the stress-diarrhea link) directly is to activate the mast cells (little chemical warfare depots that release all sorts of nasty things to get rid of parasites, etc) the mast cells release it's chemicals and the cells that line the gut dump in water and mucous and the nerves are signalled to cause wave after wave of contrations until you are empty. I also think that for some people with food intolerances (the ones that only get sick if they know they ate it--but don't in a blind challenge) may be this same response. Your brain decided that X food was bad and everytime you eat it, the brain activates the mast cells and away we go.There are some studies that see altered levels of neurotransmitters (the chemical signals that are the way the nerves transmit from one to the next) in IBS patients. At least two receptors have been identified in the gut that drugs can target. 5HT-3 and 5HT-4. Serotonin binds to these receptors (usually a chemical binds to more than one type of receptor and they are numbered in the order they are discovered). If you put serotonin (5HT) on a 5HT-3 receptor the gut speeds up, and on 5HT-4 the gut slows down. Kinda like the accelerator and the brake on a car. By using drugs you can block the receptors, so blocking the 5HT-3 is kinda like putting a governor on the accelerator pedal, you can't push it all the way down and go too fast. Blocking the 5HT-4 is like greasing the brakes so you can't be slowed down as easily.HTHK.
 

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And Eric, thanks for the encouragement. I dunno why, but that nerves have anything to do with IBS seems to occasionally get really negative responses (at least that's how it felt over on the Candida thread...sigh). I dunno why nerve problems, get such a negative response sometimes. I wonder if it has to do with wanting to find something that is attacking us, rather than think that our bodies (or our bodies nervous system) has betrayed us. Or that we think we should be in control of the parts of the nervous system that work essentially independant of the concious thought process. So we fear that if it is found to be f**ked up nerves rather than some invading organism that we are somehow at fault for being sick. K.
 
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Umm, wow. Lot's of good info in this thread.As a side note, Eric, would you be willing to give that ISB explanation post it's own topic and put it in as a new post? I was going to do it, but thought that might be rude of me.It's very simple, laymans terms, and it validates us very well. I copied it and sent it to friends and family who don't get it!!OK, as for pain, I kinda agree with the mind-gut thing. ALL pain affects my gut, even the nasty bruise I got from wrestling with a friend's 115 pound boxer the other day (dumb, I know)With my endo, the doc sez a spec of it the size of a pin head can cause more pain than one the size of a golfball, depending on location, etc.When I go to the ER for the kidney stones, or this latest bout with a cycst, they always ask me to 'rate' my pain on a 1-10 scale. A 5 might be intolerable for one person, where another can take an 8.For example, when it is a kidney stone, I would usually rate that as a 10 in intensity. But, I don't go to the ER, because I know what it is and I know how it will progress. If it veers off it's normal course, I go to the ER.The pain from the cyst was immediately a 10, but it also felt like a really bad D attack, so I waited. When it didn't follow the usual pattern, I went to the ER.I know I'm rambling here, I'm not as good at this as many of you are. What I'm trying to say is pain also has something to do with pattern. If the pattern is normal for us, we tend not to 'feel' it as much as when it veers off course. I don't freak out over intense kidney stone pain, or intense IBS pain. But, say I had intense pain from a headache, or an intense, different pain in my back. THAT would send me to a doc for help.OK, done now...sorry for the rambling------------------Color Rainbows in the Rain
 

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Discussion Starter · #12 ·
This is a good discussion and I have a lot to add to this thread that will really help.I am working another job for two weeks so I am rushed for time at the moment, although I will have a little maybe through out the day, but BQ read this as well. http://www.usnews.com/usnews/issue/000403/gut.htm K, I agree there is so much new information on IBS, but sometimes it just seems ignored in a way. I think partly from the confusion of tring to figure it out and from what you have said. I still think education on what it is and how to effectively manage it is important as it can get.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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At the risk of sounding thick, I'm not really sure what you're asking Eric, sorry. Could you clarify?Do you mean what is the origin of the pain?Do you mean do we perceive the source and severity of the pain correctly?susan
 

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Thanks K & Eric. K, I've read your latest post here 4 times now(this is embarrassing, yikes! like I'm back in the 4th grade looking at fractions!) I think I'm beginning to understand. Another analogy, the receptors in our guts are like those permanently blinking orange traffic signals that are lit up but not sending the right message? Like the elec. is there but the signal doesn't do its job? Have I got it?Eric, the pain thing.... I talked to a friend of mine and told her (out loud) that I have pain AND I have trouble saying it. She simply said, "You judge your pain. Don't do that. Just give the Dr. the facts and let him judge it." Now when she said that I had a "Aha!" moment if you know what I mean. I think this could help me start communicating it better to the Dr. I'll have to keep Dragnet in mind when I talk to him. I read some of the articles that you linked above. They were definitely helpful. I will, however,have to re-read some of them again to completely understand. My head hurts something awful....maybe I'm thinking too hard.
Thanks is not enough... I am trying and I know I couldn't know what I know without you all...BQ
 

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Discussion Starter · #15 ·
Marilyn, hope you feel better and I will bein touch.Hotmeow, I will post this to another thread, although its all related but your right it might help.Susan both.
BQ, I have been seriously studying this for the two years I have been on the bb and with the help of some top doctors as well as this bb, and trying to figure it out all my life. It still sometimes gives me a headache and there are still somethings that are not totally clear for me.
So try to digest(LOL) a little at a time, but you are on the right track. It is true what your friend said. I also like "just the facts,mam" from dragnet.
I am going to add some cool techniques to this on pain also.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com
 

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Either the signal isn't doing it's job (flashing yellow), or you could be getting the wrong signals. Like having the red, green and yellow occuring at random in one of the 4 directions at the intersection with the other 3 directions behaving properly. Sometimes it's OK, and sometimes it can be really bad news, the stopped clock has the right time 2X a day phenomenon. And in some cases the signal goes screwy only under certain circumstance, in others it may be messed up most of the time.K.
 
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Great discussion. I'd like to ask a related question: how many of you out there do not experience the pain that Eric and the others mention? I've been "suffering" from IBS-D for over twenty years. At least every other day I get hit with a horrible, uncomfortable urgency to move my bowels, but this feeling is no different than the urgency I experienced when I occasionally had "normal" D
in my pre-IBS days. When I have one of my many 7 or 8 trips to the bathroom days, I end up tired, achy and miserable. But none of this sounds like the real pain that so many others describe.I doubt very much that it has anything to do with pain tolerance. In other areas (e.g. the dentist's chair, sports injuries, cooking burns), I do not perceive that I handle pain better than the average person. Probably not even as well as the average person.Anyone with a similar experience of IBS?
 

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K, Nice refinement! Can you tell that I'm a "things are either black or white " type gal? I always did have trouble with grey. Oh well, I'm a work in progress. Eric & K I'm so grateful for your shared knowledge, patience and time. You have helped me more than you know. Thanks to you & others I feel like I'm reaching a different level of acceptance & management of IBS. Thanks x's a million! BQ (ie: IT doesn't have me; I have IT.)[This message has been edited by BQ (edited 01-23-2001).]
 
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My expeariance with the pain of IBS seams very odd to me. I think I have a very high pain tolerance and I deal with crohnes daily relitivly well I think. I have dealt with crohnes for about 15 years and I almost never miss work. I genraly always have bigD and some anal bleeding, and Im almost always very tender down there but the thing that is keeping me up at night is a itch. I just cant ignore it and fall asleep. and if I itch it at all it just gets worse. At least it isnt that bad during the day but I just dont know what to do at night.I hope every ones nights and days get better soon.
 

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ZenBuddha,One of the problems with itching is the mind. It expects a certain amount of input from the body all the time. With itching, which is usually a low priorty sensation, during the day you've filled all the slots with higher priority things like just where is that truck hurtling towards me.At night as you fall asleep, you mind still wants input, but all it finds is I itch, so it focuses on the itch...and won't let go of the itch as there is nothing more interesting going on.I find two things that help with itch (I have all over body itch...it's tons of fun trying to sleep) The first is doxepin. It is an potent antihistamine and an antidepressant. I've got weird histamine receptors so I need something like that to block the histamine thing. Also for small areas, two things. Get some clove oil (you can use this in your mouth, don't know about other sensitive spots)and mix it into a moisturizer (most pharmacies carry clove oil with the mouth pain meds...it's old fashioned but it works) and apply to the itchy spot. That usually numbs it for several hours which allows me to go to sleep.Itchily yoursK.
 
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