title: Widespread hyperalgesia in adolescents with symptoms of irritable bowel syndrome: results from a large population-based study.
abstract: Widespread hyperalgesia is well documented among adult patients with irritable bowel syndrome (IBS), but little is known about pain sensitivity among adolescents with IBS. We examined pain sensitivity in 961 adolescents from the general population (mean age 16.1 years), including pain threshold and tolerance measurements of heat (forearm) and pressure pain (fingernail and shoulder) and cold pressor tolerance (hand). Adolescents with IBS symptoms (Rome III criteria) had lower heat pain thresholds compared to controls after adjustments for sex, comorbid pain, and psychological distress (mean difference = -.8 °C; 95% confidence interval [CI] = -1.6 to -.04). Similar results were found for pressure pain threshold at the shoulder (mean difference = -46 kPa; 95% CI = -78 to -13) and fingernail (mean difference = -62 kPa; 95% CI = -109 to -15), and for an aggregate of all 3 threshold measures (z-score difference = -.4; 95% CI = -.6 to -.2), though pressure pain threshold differences were nonsignificant after the final adjustments for psychological distress. No difference of pain tolerance was found between the IBS cases and controls. Our results indicate that adolescents in the general population with IBS symptoms, like adults, have widespread hyperalgesia.
  
  
  CONCLUSIONS
  This is the first report of widespread hyperalgesia among adolescents with IBS symptoms in the general population, with lower pain thresholds found to be independent of sex and comorbid pain. Our results suggest that central pain sensitization mechanisms in IBS may contribute to triggering and maintaining chronic pain symptoms.
authors.affiliation: Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, University of Tromsø, Tromsø, Norway. Electronic address: niklas.stabell@unn.no.
authors.forename: Niklas
authors.initials: N
authors.lastname: Stabell
authors.affiliation: Department of Pain Management and Research, Oslo University Hospital and Faculty of Medicine, Oslo University, Oslo, Norway.
authors.forename: Audun
authors.initials: A
authors.lastname: Stubhaug
authors.affiliation: Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Flægstad
authors.affiliation: Oppenheimer Family Center for the Neurobiology of Stress, Division of Digestive Diseases, Los Angeles, California.
authors.forename: Emeran
authors.initials: E
authors.lastname: Mayer
authors.affiliation: Department of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Naliboff
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Nielsen
mesh_terms: D000293:Adolescent; D001132:Arm / Q000503:physiopathology; D003080:Cold Temperature; D015897:Comorbidity; D005260:Female; D006358:Hot Temperature; D006801:Humans; D006930:Hyperalgesia / Q000453:epidemiology / Q000503:physiopathology*; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology / Q000503:physiopathology; D010147:Pain Measurement; D017288:Pain Threshold; D011312:Pressure; D015995:Prevalence; D012737:Sex Factors
keywords: Widespread hyperalgesia; adolescents; comorbidity; irritable bowel syndrome; quantitative pain sensitivity testing