Tolerable pain reduces gastric fundal accommodation and gastric motility in healthy subjects: a crossover ultrasonographic study.
BACKGROUND
Obstacles to pain management include patients' reluctance to inform healthcare provides about their pain, and differences in the pain management aims between patients and healthcare providers. The objective of this study was to evaluate whether tolerable pain influences gastric fundal accommodation and gastric motility in healthy subjects.


METHODS
We undertook a crossover comparison study to evaluate gastric fundal accommodation and gastric motility in 74 healthy subjects in the presence or absence of tolerable pain. The intensity of tolerable pain was defined as the upper limit of pain compatible with comfortable daily life. Pain was generated by clipping a clothes pin to the ear lobe, and the intensity of pain was adjusted by inserting the gauze between the ear lobe and the pin. Gastric fundal accommodation and gastric motility were assessed by external ultrasonography. The cross-sectional area of the proximal stomach was measured after subjects had taken 100 mL-liquid meals four times, then the amplitude and frequency of antral contractions were measured.


RESULTS
The median numerical rating scale of tolerable pain was 3 (interquartile rang 2-4). Gastric fundal accommodation, gastric motility and gastric emptying were all significantly impaired by tolerable pain (P< 0.001 for all comparisons).


CONCLUSIONS
Even tolerable pain can reduce gastric fundal accommodation and gastric motility, which could result in anorexia or decreased quality of life. Our findings provide important insights into pain management education for patients tolerating pain and healthcare providers encouraging patients to tolerate pain. This study was registered retrospectively.
Department of Psychosomatic Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka Japan.
Hideaki
H
Hasuo
Department of General Medicine, Kawasaki Medical Univesrity, Matsushima 577, Kurashiki, Okayama Japan.
Hiroaki
H
Kusunoki
Department of Psychosomatic Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka Japan.
Kenji
K
Kanbara
Department of Psychosomatic Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka Japan.
Tetsuya
T
Abe
Department of Internal Medicine, Akaiwa Medical Association Hospital, Shimoichi 187-1, Akaiwa, Okayama Japan.
Naoko
N
Yunoki
Department of General Medicine, Kawasaki Medical Univesrity, Matsushima 577, Kurashiki, Okayama Japan.
Ken
K
Haruma
Department of Psychosomatic Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka Japan.
Mikihiko
M
Fukunaga
Gastric fundal accommodation; Gastric motility; Pain management; Tolerable pain; Ultrasonography