quote:The American Journal of GastroenterologyDecember 2002 (Volume 97, Number 12)Is There a Difference Between Abdominal Pain and Discomfort in Moderate to Severe IBS Patients?Sach J, Bolus R, Fitzgerald L, Naliboff BD, Chang L, Mayer EAThe American Journal of Gastroenterology. 2002;97(12):3131-3138Current diagnostic criteria for irritable bowel syndrome (IBS) do not distinguish between abdominal pain and abdominal discomfort. Whereas the concept of "pain" represents a specific sensation, the report of associated discomfort is somewhat subjective because it can be reflective of a broad range of symptoms, including sensations of bloating, fullness, incomplete evacuation, urgency, or even "discomfort" during bowel movements. However, the relative contribution of such nonpainful clinical presentations to the overall associated increased morbidity seen in this setting has never been evaluated. Therefore, Sachs and colleagues set out to determine whether there are clinical differences between discomfort-predominant and pain-predominant IBS patients.This study involved 256 consecutive patients with IBS, as defined by ROME I criteria. Patients with moderate-to-severe symptoms were then stratified with respect to whether they rated their predominant IBS symptoms as pain (n = 52; pain-predominant) or as nonpainful discomfort (n = 128; discomfort-predominant) on the Irritable Bowel Syndrome Quality of Life questionnaire. To ensure appropriate subcategorization of patients, a subsample (n = 45) was interviewed by a nurse practitioner blinded to the responses given on the patients' questionnaires. Validated survey instruments were used to evaluate IBS-specific symptom presentations, make psychometric assessments, and obtain quality-of-life measures.These investigators found that nearly twice as many individuals self-classified their primary symptoms as abdominal discomfort rather than abdominal pain. They also found good agreement between the clinical judgment of the blinded interviewer and the patient self-reports given on the questionnaire regarding assessment of pain vs discomfort predominance (r = 0.77; P < .05). There was no significant difference in overall gastrointestinal symptom severity ratings between the pain- and discomfort-predominant IBS groups. The groups also demonstrated no differences in age, sex, predominant bowel symptom, and reported similar levels of psychological stress, impairment in quality of life, and increased physician visits.The study authors conducted this present investigation to test their hypothesis that patients with IBS who experience abdominal pain (vs discomfort) as their predominant symptom would demonstrate a greater severity and duration of IBS symptoms, higher incidence of psychological disturbances, greater impairment in their quality of life , and increased utilization of healthcare resources. Although patients who self-classified their symptoms as pain-predominant consistently ranked upper and lower pain severity higher than did patients who self-classified their abdominal symptoms as discomfort-predominant, despite similar overall gastrointestinal severity scores, the findings reported do not support the initial hypothesis. That is, there were no group differences found with respect to overall gastrointestinal symptom severity and duration, psychological symptom severity, health-related quality of life, or frequency of physician visits.Based on these findings, although patients do indeed classify their IBS symptoms as either "pain" or "discomfort," it may be suggested that self-reported abdominal pain is not the most debilitating symptom in patients with IBS. Rather, these data are likely more consistent with there being a cognitive labeling bias, in which similar sensations are reported as "painful" by some individuals and "discomfort-like" by others.
