Galvanic Skin Response—Extinction Biofeedback Training for Psychogenic Abdominal Pain: A Validation Protocol

Abdominal and pelvic pain of psychogenic origin is a widespread, disabling, difficult to identify, and often inadequately treated medical condition. This condition is often associated with poor quality of life due to high pain interference with daily activities. Cognitive behavioral psychological therapy and neuromodulation with biofeedback are validated therapies for the treatment of this condition. Aim of the present research work is the validation of a therapeutic protocol that involves the use of both techniques in combination. 20 patients diagnosed with psychogenic abdominal pain, of both sexes, aged between 18 and 60 years who had not benefited from pharmacological therapies were enrolled. 10 patients were randomly assigned to the control group (psychological treatment only), another 10 patients were assigned to the study group (neuromodulation with biofeedback-Galvanic skin response-extinction in combination with psychological therapy). For both groups, the pain score, interference of pain with daily living activities, pain relief, and the share of anxiety associated with the pain condition were evaluated (pre- and post-treatment). The patients who underwent the combined treatment achieved statistically significant better scores than patients in the control group, respectively −4.9 ± 0.9 vs −1.0 ± 0.4 for Pain;−5.1 ± 1.1 vs −0.9 ± 0.3 for Interference with life;−7.2 ± 3.7 vs −2.2 ± 2.1 for HAMA;4.6 ± 1.2 vs 1.1 ± 0.6 for Relief.

Involvement of toll-like receptor 5 in mouse model of colonic hypersensitivity induced by neonatal maternal separation

BACKGROUND Chronic abdominal pain is the most common cause for gastroenterology consultation and is frequently associated with functional gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease. These disorders present similar brain/gut/microbiota trialogue alterations, associated with abnormal intestinal permeability, intestinal dysbiosis and colonic hypersensitivity(CHS). Intestinal dysbiosis can alter colon homeostasis leading to abnormal activation of the innate immunity that promotes CHS, perhaps involving the toll-like receptors(TLRs), which play a central role in innate immunity.AIM To understand the mechanisms between early life event paradigm on intestinal permeability, fecal microbiota composition and CHS development in mice with TLRs expression in colonocytes.METHODS Maternal separation model(NMS) CHS model, which mimics deleterious events in childhood that can induce a wide range of chronic disorders during adulthood were used. Colonic sensitivity of NMS mice was evaluated by colorectal distension(CRD) coupled with intracolonic pressure variation(IPV) measurement. Fecal microbiota composition was analyzed by 16S rRNA sequencing from weaning to CRD periods. TLR mRNA expression was evaluated in colonocytes.Additionally, the effect of acute intrarectal instillation of the TLR5 agonist flagellin(FliC) on CHS in adult naive wildtype mice was analyzed.RESULTS Around 50% of NMS mice exhibited increased intestinal permeability and CHS associated with intestinal dysbiosis, characterized by a significant decrease of species richness, an alteration of the core fecal microbiota and a specific increased relative abundance of flagellated bacteria. Only TLR5mRNA expression was increased in colonocytes of NMS mice with CHS. Acute intrarectal instillation of FliC induced transient increase of IPV, reflecting transient CHS appearance.CONCLUSION Altogether, these data suggest a pathophysiological continuum between intestinal dysbiosis and CHS, with a role for TLR5.