Brief pain is something your brain and body can handle with ease. But chronic pain, especially if it is originating from the abdomen, is an entirely different story.
Chronic abdominal pain can have complex and lasting effects on your brain. It changes how the brain responds to pain signals. Eva Szigethy, a professor of psychiatry and medicine and the founder of the Visceral Inflammation and Pain (VIP) Center at the University of Pittsburgh School of Medicine, calls it the “traumatizing aspects” of chronic abdominal pain.
Szigethy coauthored an article published in GI and Hepatology News exploring the connection of chronic abdominal pain to brain function. Chronic abdominal pain can be due to inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) or other health condition. This pain is distressing, debilitating and traumatizing.
Szigethy defines trauma as the brain and the body’s reaction to anything that threatens a person’s safety. Perceived threats that lead to trauma normally come from the outside, such as the threat of violence from another person or group. However, trauma can also come from within the body. Chronic abdominal pains lasting longer than three months can also be traumatizing — a strong neurobiological connection between the brain and the gut may help explain why.
“You not only have the continued signal coming from the gut, but now you have secondary responses from the brain that perpetuate the negativity,” said Szigethy. “So now you have worry, catastrophic thinking, you emotionally become very anxious and depressed. You become hypervigilant to this signal because it’s persistent and perceived as dangerous.”
The ongoing pain can rewire your brain as different brain systems provide a greater response to what is seen as dangerous.
According to Szigethy, people experiencing chronic abdominal pain are not just suffering from the pain itself. They also suffer from cognitive and behavioral reactions to the pain, including anticipatory worrying about pain, inability to think about the future and mood changes like irritability.
Long-term pain confuses the brain and eventually causes the aforementioned issues, Szigethy explained.
“We’re supposed to have pain intermittently – find the cause, do something about it. And then it goes away, and we go back to being our centered selves,” she said. “When pain doesn’t go away, it dysregulates communication pathways, both the chemical and electric ones, and the negative cycles of pain and worry start winning.”
Gut-brain connection goes both ways
A person’s stomach or intestinal distress can be the cause or the product of anxiety, stress or depression. That is because the gut and brain connection goes both ways and the brain and the gastrointestinal (GI) system are intimately connected.
The gut-brain connection is real: It can link anxiety to stomach problems and vice versa.
The gastrointestinal tract is sensitive to emotions such as anger, anxiety, sadness and elation. All of these feelings (as well as the other emotions) can trigger symptoms in the gut. Meanwhile, the brain has a direct effect on the stomach and intestines. The very thought of eating can release the stomach’s juices before the food gets there.
A troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. The close interactions between the brain and the gut make us understand why a person may feel nauseated or feel intestinal pain during times of stress. (Related: Is depression just a symptom of bad gut health? Study confirms link between gut and brain health.)
Many people with functional GI disorders have brains that are more responsive to pain signals from the GI tract so they perceive pain more acutely than other people do. They experience more stress and stress makes existing pain even worse than it seems.
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