Just fyi, but Gut focused HT has the highest reponce rate to date for IBS statistically.
It does not work for every single person, but for about 80 percent or more. It has also been shown to work after five years of treatment, which really suggests it is working on the actual physical problems.
"Why Consider Hypnosis Treatment for IBS?
by Olafur S. Palsson, Psy.D.
Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients (click here for discussion of treatment options for IBS). However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:
- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date.
- The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).
- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.
- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects.
- The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.
- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms."
http://www.ibshypnosis.com/whyhypnosis.html
This is one of the top senior gastroneterologists in the UK also.
"At a meeting this week of the World Congress of Psychosomatic Medicine, gastroenterologist Peter Whorwell, MD, will discuss more than 20 years of research showing that hypnosis can not only improve symptoms of irritable bowel syndrome, or IBS, but can even alter the underlying physical problems that cause the symptoms. "
http://www.webmd.com/content/article/34/1728_87469
It can also boost the immune system.
Its also has been shown to work on non gi symptoms.
with permission from the UNC
IBS – Beyond the Bowel: The Meaning of Co-existing Medical Problems
IBS – Beyond the Bowel:
The Meaning of Co-existing Medical Problems
Olafur S. Palsson, Psy.D. and William E. Whitehead, Ph.D.
UNC Center for Functional GI & Motility Disorders
Irritable bowel syndrome (IBS) is a disorder that is defined by a specific pattern of
gastrointestinal (GI) symptoms in the absence of abnormal physical findings. The latest
diagnostic criteria for IBS -- the Rome II criteria created by an international team of
experts -- require that the patient have abdominal pain for at least 12 weeks within the
past 12 months and that the pain meets two of the following three criteria: it is relieved
after bowel movement, associated with change in stool frequency, or associated with
stool form. It is becoming clear, however, that these bowel symptoms do not tell the
whole story of symptoms experienced by IBS patients. People with this disorder often
have many uncomfortable non-gastrointestinal (non-GI) symptoms and other health
problems in addition to their intestinal troubles.
SYMPTOMS ALL OVER THE BODY IN IBS
Several research reports have established that IBS patients report non-bowel symptoms
more frequently than other GI patients and general medical patients. For example, four
studies that have asked IBS patients about a wide variety of body symptoms(1-4) all found
headaches (reported by 23-45% of IBS patients), back pain (28-81%), and frequent
urination (20-56%) to be unusually common in individuals with IBS compared to other
people. Fatigue (36-63%) and bad breath or unpleasant taste in the mouth (16-63%) were
found in three of these four studies to be more common among IBS patients, as well.
Furthermore, a large number of other symptoms have been reported to occur with
unusually high frequency in single studies. In our recent systematic review of the medical
literature(5), we found a total 26 different symptoms, listed in Table 1, that are reported to
be more common in IBS patients than comparison groups in at least one study.
Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndrome
patients than in comparison groups(5).
1. Headache
2. Dizziness
3. Heart palpitations or racing heart
4. Back pain
5. Shortness of breath
6. Muscle ache
7. Frequent urinating
8. Difficulty urinating
9. Sensitivity to heat or cold
10. Constant tiredness
11. Pain during intercourse (sex)
12. Trembling hands
13. Sleeping difficulties
14. Bad breath/unpleasant taste in
mouth
15. Grinding your teeth
16. Jaw pain
17. Flushing of your face and neck
18. Dry mouth
19. Weak or wobbly legs
20. Scratchy throat
21. Tightness or pressure in chest
22. Low sex drive
23. Poor appetite
24. Eye pain
25. Stiff muscles
26. Eye twitching
OVERLAP WITH OTHER MEDICAL CONDITIONS
Results from numerous studies (reviewed by Whitehead, Palsson & Jones, 2002(5)) also
indicate that IBS overlaps or co-exists more often than would be expected with other
medical conditions that appear to have little logical connection with the gut. The most
researched example of such an overlap is the co-existence of IBS with fibromyalgia, a
disorder characterized by widespread muscle pain. Fibromyalgia affects an estimated 2%
of the general population, but 28-65% of IBS patients have the disorder. Similar results
are obtained when this overlap is examined the opposite way, by studying fibromyalgia
patients and looking for IBS -- 32-77% of fibromyalgia patients have IBS.
Chronic fatigue syndrome (CFS) is another medical condition that has been found to have
many times the expected co-occurrence with IBS. CFS is thought to affect only 0.4% of
the general population, but it has been reported in 14% of IBS patients. Conversely, 35-
92% of chronic fatigue syndrome patients have IBS. Other conditions documented in
multiple studies to have excess overlap with IBS are temporomandibular joint disorder
(TMJ), found in 16-25% of IBS patients(2,6), and chronic pelvic pain (35% of IBS
patients(7). In addition to these well established relationships, many other medical
conditions appear (judging from single study reports) to have an excess overlap with IBS,
although the frequencies of most of them in IBS are much lower than for the disorders
already discussed. In fact, we recently( compared the frequencies of a broad range of
diagnoses in the medical records of 3153 IBS patients in a large health maintenance
organization in the U.S. Northwest to an equal number of non-GI patients in the same
HMO, and found that the IBS patients had a higher frequency of almost half of all non-GI
diagnoses, or 64 of the 136 sampled diagnoses.
In summary, non-GI symptoms and co-existing medical problems seen in many IBS
patients far exceed what is typical for medical patients or GI patients in general. This
raises important questions about what causes this phenomenon and what the implications
are for IBS patients.
WHAT EXPLAINS NON-GI SYMPTOMS AND CO-EXISTENCE OF OTHER DISORDERS IN IBS?
There are several possible explanations for the preponderance of general symptoms and
disorders in IBS. Our research group is engaged in several research studies that may help
shed some light on this mystery, but it is still too early to come to definitive conclusions.
We will list here some of the possible explanations, and discuss relevant data coming
from work by our team and other investigators.
1. A common physical cause? One explanation for the high rates of co-existing
symptoms and conditions in IBS patients would be that there is something biologically
wrong in IBS patients that also causes other symptoms or conditions. There are a number
of distinct physiological characteristics or "abnormalities" seen in many IBS patients,
although none of them are found in all IBS patients. These include: heightened pain
sensitivity in the gut, increased intestinal contractions (motility) or hyper-reactivity in
response to meals or stress (too much movement of the intestines – this is the reason why
IBS was called spastic colon in the past), patterns of dysfunction in the autonomic
nervous system (that part of the nervous system that helps regulate our inner body
functions), and vague signs of immune activation seen in some IBS patients. Although
one could suggest ways in which these physiological abnormalities would play a role in
some other disorders that co-exist with IBS, there is little evidence so far of a common
pattern of physical abnormality that could link IBS and its most common coexisting
conditions and symptoms. Patterns of autonomic dysfunction in IBS are not like the ones
seen in fibromyalgia and chronic fatigue syndrome, for example. And, fibromyalgia
patients do not show the same gut pain sensitivity as IBS patients, while conversely, IBS
patients do not show the pain-sensitive tender points that are characteristic of
fibromyalgia(9-10). Furthermore, as can be seen from reviewing the symptom list in Table
1, the non-GI symptoms that plague IBS patients are so varied and cover so many
different organ systems, that it would be hard to identify a specific biological connection
between them. On the contrary, it seems like the only overall commonality between these
symptoms may be that they are non-specific – they are, in other words, not clear
symptoms of any identifiable disease processes or diagnosable disorders. Indeed, the
symptoms that are most common among IBS patients are generally those that are also
common in the general healthy population – they just tend to occur at a higher level in
people with IBS.
2. Physical expression of emotional discomfort?
Another possible explanation for the high number of non-GI symptoms and disorders in
IBS patients is the tendency to translate strong emotions into physical symptoms. This is
sometimes called somatization ("soma" is the Greek word for "body" and somatization
therefore literally means "to express in the body"). All people "somatize" to some degree;
it is normal to feel butterflies in your stomach, to blush or go pale, get a lump in your
throat, or feel the heart beating in your chest when you get very emotional. Shaky hands,
stiff neck or excess sweating are likewise quite ordinary when people are under a great
deal of stress. However, some people are more vulnerable than others to letting negative
emotions express themselves physically. This is often thought to be an alternative and
less healthy way of exhibiting or feeling emotional discomfort. Some people may
develop a strong tendency to do this because they have a basic personality trait that shies
away from interpersonal expressiveness. For others, it could be the result of growing up
in the care of strict, repressive or abusive parents or caretakers, where normal expression
of negative emotions was not allowed or would have been dangerous. Getting a headache
or a stomach ache may be an alternative way to "give voice" to negative emotions under
such circumstances. It seems that excessive habitual suppression of ordinary verbal and
emotional expressions of negative emotions, regardless of the reason for it, may lead to
the tendency to somatize. There is evidence that this tendency may be at work in IBS, at
least among some women with the disorder. Dr. Brenda Toner has found in two
studies(11-12) that women with IBS score higher than depressed women and healthy
women on questionnaires measuring of the tendency to avoid the expression of negative
emotions or views.
3. Learned over-attention to body symptoms and excess disease attribution?
All people ignore most of the sensations from their bodies most of the time. This is
necessary so that we are not overwhelmed by the vast amount of information our senses
supply to our brains every moment of our lives. For example, if you are reading this
sitting down, you have probably not been at all aware of the sensations of the seat under
your body until right now. Our brains constantly sift through the mass of incoming body
information and decide what is important for us to become consciously aware of, based
on such things as our past experiences and how likely the information is to indicate a
threat to our health or well-being. Most minor symptoms (those that might be
uncomfortable and bothersome if they would get our attention), are simply dismissed in
our busy everyday lives, because other things win out in the moment-to-moment
competition for our limited attention resources.
More frequent attention to mild physical symptoms can be learned, however, and can
become a habit. As with most things, such habitual over-attention is probably most easily
learned in childhood. It would seem reasonable, for example, that a child could get into
the habit of noticing physical symptoms more if his or her parents are always talking
about their own symptoms. We have recently found(13) that the more medical problems
the parents in the childhood home had, the more general physical symptoms adult IBS
patients report. The possible consequence of a childhood where the child grew up with
parents or others who were seriously ill, is a tendency to interpret common normal
physical sensations as symptoms of serious illness. Such a serious view of symptoms can
also be modeled after the parent's approach to common illness. Dr. Whitehead and
colleagues found in a telephone survey of 832 adults 20 years ago(14) that people whose
parents paid more attention to cold or flu symptoms in childhood were more likely to
view such symptoms as serious in adulthood and to visit doctors for them. They were also
more likely to have IBS diagnosis.
Evidence that IBS patients interpret physical sensations differently than others is
emerging from brain imaging studies. This type of research takes a "snapshot" of the
amount of activity in different parts of the brain in response to sensations, using
techniques such as PET scans (positron emission tomography) and fMRI (functional
Magnetic Resonance Imaging). By examining which parts of the brain react the most to
painful sensations, it is possible to deduce to some degree how the brain processes the
information. In one such study, by Silverman and colleagues(15), IBS patients but not
control subjects reacted to physical sensations from a painful balloon inflation in the
rectum with increased blood flow in the left prefrontal cortex, a part of the brain known
to process personally threatening information. In contrast, this study and others(16-17)
found that IBS patients do not show activity in the anterior cingulate cortex that is
indicative of general discomfort in healthy subjects. IBS patients are also more likely to
respond to physical stimuli in the GI tract by activating brain centers that handle
emotional events. Collectively, this suggests that IBS patients may process body
information associated with bowel sensations (and perhaps other physical sensations, as
well) differently than other people, interpreting them as personally threatening and more
emotionally relevant events rather than just ordinary discomfort. Such different
interpretations of physical sensations would also explain hyper-attention to such
sensations.
4. Faulty neurological filtering?
After entering the spine (the information highway from the body to the brain),
information destined for the brain about body pain is sent along nerves through gates that
control how much of this information passes through. Our brains continually send signals
down these spinal gates to cause them to block signals that are of too low intensity to
provide valuable information (you do not want to constantly know about all of your
minor aches and discomforts from regular body activity). This is one of the ways the
brain uses to limit the vast amounts of information constantly streaming in from millions
of nerve sensors throughout our bodies. A current popular hypothesis in the field of IBS
research is that an inadequate amount of this "descending inhibition" of incoming pain
information is, at least partly, to blame for the hypersensitivity to intestinal discomfort
and pain seen in IBS patients. Some researchers have further suggested that the same
kind of slack traffic control could be more widespread in IBS patients and may explain
the observed proneness to headaches, back pain or muscle aches. People who have more
open pain gates because of faulty inhibition would theoretically be like the princess in
"The Princess and the Pea." who could feel a pea through 20 mattresses. The problem
with this as an explanation for symptom overabundance among IBS patients is that it
would explain only excess in pain-type symptoms, which are just one of many types of
overabundant symptoms in IBS. There are also no direct data on IBS patients to prove
how valid this view is.
5. Result of greater psychological distress?
As was explained earlier, it is normal for people who are emotionally distressed to
experience more physical symptoms. At least half of IBS patients who have consulted
doctors have been diagnosed with an affective ("emotional") disorder – generally either
depression or an anxiety disorder. Additionally, many people with IBS who have no
affective disorder diagnosis have significant symptoms of anxiety and depression. One
might, therefore, ask whether the physical symptoms reported could simply be a side
effect of psychological distress.
We have addressed this question in two studies presented at the 2003 Annual Meeting of
the American Gastroenterological Association(18-19). In the HMO data mentioned earlier
(1, we found that having a psychological diagnosis was associated with increased
numbers of physical diagnoses that these IBS patients had received (from an average of
7.1 to 9.7). However, we also found that even patients with no psychiatric diagnosis had
more physical diagnoses per person than the other HMO patients (7.5 vs. 5.5), so the
presence of psychological problems is not the whole answer. In the other study(19), we
examined the relationship between depression and anxiety scores of 795 people with IBS
and the number of physical symptoms they had experienced over the past month.
Statistical methods that estimate how much of the variability in one measured
characteristic can be explained by other measured factors tell us that the psychological
symptoms roughly accounted for 25-30% of physical symptoms of these people. In short,
psychological distress is almost certainly part of the explanation for greater body
symptoms in IBS, but not nearly the whole story.
Further research will have to determine which of the above explanations are applicable in
IBS, but it is likely that more than one of them, and maybe some other factors
unrecognized so far, work together to account for the high frequency of symptoms and
disorders that co-exist with IBS.
THE IMPACT OF EXTRA PHYSICAL SYMPTOMS AND DISORDERS ON IBS PATIENTS.
What do these extra ("non-IBS") symptoms and co-existing medical conditions mean in
practical terms for patients with IBS? The first thing to note is that not all IBS patients
experience additional health problems and symptoms, so it is not a concern for all people
with IBS. For those who do, however, symptoms and disorders beyond the bowel can add
measurably to the overall burden of illness for the individual and also lead to greater
health care needs and health care costs for IBS patients.
It is by now well established that IBS patients visit doctors more than the general
population. Only recently has it been recognized, howver, that most of the extra health
care visits that people with IBS make are not for their bowel problems. Levy et al.(20)
reported that IBS patients had about twice as many doctor visits compared to other
patients in the same HMO, but they found that 78% of the additional visits were due to
problems other than IBS. It seems quite likely that these extra non-GI doctor visits of IBS
patients are due to the tendency to experience more general body symptoms over time,
based on study results we presented at the Annual Meeting of the American
Gastroenterological
Association last year(21). Using
a scale asking patients about
the 26 physical symptoms in
Table 1, we found that those
IBS patients who report an
unusually high number of these
symptoms over the past month
missed six times as many days
from school or work due to
illness (see Figure 1)
compared to those with low or
moderate (normal) symptoms.
The "high-symptom" IBS
patients also had twice as many
doctor visits and more hospital
days (Figure 2), and their quality
of life was furthermore
measurably poorer on the
average.
A general tendency to have a
large number of body symptoms
is, therefore, very costly in terms
of the IBS patient's overall wellbeing
and ability to function
normally in life, and increases
substantially the health care costs
for these individuals. These
findings clearly underline the
need to find a way to help the
many IBS patients who score unusually high on body symptom questionnaires to reduce
that tendency.
IS IT POSSIBLE TO REDUCE NON-GI SYMPTOMS IN IBS?
It is unknown to what degree standard medical treatment for IBS, when successful, also
results in improvement in non-GI symptoms. The problem is that most IBS treatment
research has not examined how non-IBS symptoms change. Non-IBS symptoms have
also not been a focus of standard IBS treatment. An exception to this is psychological
treatment trials for IBS, which sometimes have included general physical symptom
questionnaires among the measures of treatment effects. We, therefore, know from our
two studies of hypnosis treatment for IBS(22) as well as from research in England(23) that
hypnosis treatment for IBS regularly improves non-GI symptoms substantially in addition
to its beneficial effects on bowel symptoms. Less is known about improvement in non-GI
symptoms from cognitive-behavioral therapy (CBT), which is the other widely
researched psychological treatment for IBS. However, there is every reason to believe
that CBT can reduce the tendency to experience a lot of general physical symptoms,
based on a review of over 30 such treatment studies(24). These benefits of psychological
treatment for IBS point to extra value of such treatments for the subgroup of IBS patients
who have many non-GI symptoms.
Research in coming years will hopefully identify other ways to improve the well-being
and life functioning of IBS patients by reducing non-GI symptoms. This is likely to
become an integral part of managing IBS effectively in the subset of patients who suffer
many symptoms and conditions beyond the bowel.
References:
1. Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel
syndrome. Gut 1986; 27:37–40.
2. Jones KR, Palsson OS, Levy RL, Feld AJ, Longstreth GF, Bradshaw BH, Drossman DA, &
Whitehead WE. Comorbid disorders andsymptoms in irritable bowel syndrome (IBS) Compared
to other gastroenterology patients. Gastroenterology 2001:120:A66.
3. Zaman MS, Chavez NF, Krueger R, Talley NJ, Lembo T. Extraintestinal symptoms in patients
with irritable bowel syndrome (IBS). Gastroenterology 2001; 120(Suppl 1):A636.
4. Maxton DG, Morris J, Whorwell PJ. More accurate diagnosis of irritable bowel syndrome by the
use of "non-colonic" symptomatology. Gut 1991; 32:784–786.
5. Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel
syndrome with other disorders: what are the causes and implications? Gastroenterology 2002 Apr;
122(4):1140-56.
6. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue
syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 2000; 160: 221–227.
7. Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and
gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynaecol
1996; 17:39–46.
8. Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ. Excess comorbidity
for somatic disorders in irritable bowel syndrome (IBS) is related to hypervigilance.
Gastroenterology 2003 (abstract in press).
9. Chang L. The association of functional gastrointestinal disorders and fibromyalgia. Eur J Surg
Suppl 1998 ;( 583):32-6.
10. Chang L, Mayer EA, Johnson T, FitzGerald LZ, Naliboff B. Differences in somatic perception in
female patients with irritable bowel syndrome with and without fibromyalgia. Pain 2000 Feb;
84(2-3):297-307.
11. Toner BB, Garfinkel PE, Jeejeebhoy KN. Psychological factors in irritable bowel syndrome. Can J
Psychiatry. 1990 Mar; 35(2):158-61
12. Toner BB, Koyama E, Garfinkel PE, Jeejeebhoy KN, Di Gasbarro I. Social desirability and
irritable bowel syndrome. Int J Psychiatry Med 1992; 22(1):99-103.
13. Whitehead WE, Palsson OS, Jones KR, Turner MJ, Drossman DA. Role of parental modeling in
somatization of adults with irritable bowel syndrome. Gastroenterology 2000; 122 (Suppl 1):
A502.
14. Whitehead WE, Winget C, Fedoravicius AS, Wooley S, Blackwell B. Learned illness behavior in
patients with irritable bowel syndrome and peptic ulcer. Dig Dis Sci 1982 Mar;27(3):202-8.
15. Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA. Regional cerebral
activity in normal and pathological perception of visceral pain. Gastroenterology 1997 Jan;
112(1):64-72.
16. Bonaz B, Baciu M, Papillon E, Bost R, Gueddah N, Le Bas JF, Fournet J, Segebarth C. Central
processing of rectal pain in patients with irritable bowel syndrome: an fMRI study.Am J
Gastroenterol 2002 Mar;97(3):654-61.
17. Bernstein CN, Frankenstein UN, Rawsthorne P, Pitz M, Summers R, McIntyre MC. Cortical
mapping of visceral pain in patients with GI disorders using functional magnetic resonance
imaging. Am J Gastroenterol 2002 Feb;97(2):319-27.
18. Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ. Comorbid psychiatric
disorders in irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
Gastroenterology 2003 (abstract in press).
19. Palsson OS, Levy R,Von Korff M, Feld A, Turner MJ, Whitehead WE. Comorbidity and
psychological distress in irritable bowel syndrome (IBS). Gastroenterology 2003 (abstract in
press).
20. Levy RL, Whitehead WE, Von Korff MR, Feld AD. Intergenerational transmission of
gastrointestinal illness behavior. Am J Gastroenterol 2000; 95:451–456.
21. Palsson, O.S., Jones K.R., Turner M.J., Drossman D.A., & Whitehead, W.E. (2002). Impact of
somatization and comorbid medical conditions on health care utilization, disability, and quality of
life in irritable bowel syndrome (IBS). Gastroenterology, 122 (Suppl 1): A501-502.
22. Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE. Hypnosis treatment for severe
irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002
Nov; 47(11):2605-14.
23. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a
large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J
Gastroenterol 2002 Apr; 97(4):954-61.
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critical review of controlled clinical trials. Psychother Psychosom 2000 Jul-Aug; 69(4):205-15.
One more, IBSers have different pet scans and fmri's then normals. This is very important.
From back in 97
http://www.ibs.med.ucla.edu/Articles/PatientArticleFl97Brain.htm
Since then they have observed abnormalities in the anterior cinculate cortex in IBS in the way it responds to pain arising from the gut. This is called viceral hypersensivity.
Three componets bring on the symptoms of IBS.
Altered motilty
viceral hypersensivity
and brain gut axis dysregulation.
Altered motility alone does not explain IBS.
--------------------
My website on IBS is www.ibshealth.com
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