From nociception to perception: breaking down the process of gut-brain signalling

This thesis investigates the process of visceral pain. In particular, it focusses on chronic visceral pain in the context of disorders of brain-gut interaction. A well-known example is irritable bowel syndrome. There appears to be various disruptions of the process from pain stimulus to perception of pain. Several of these disruptions are discussed in this thesis, starting at the level of the pain stimulus. Alterations in so-called pain sensors in the gut result in higher pain sensitivity. Subsequently, the research focusses on the role of connective tissue in pain. It has been shown that various abdominal symptoms are more common in individuals with hyperflexible joints (hypermobility). Finally, with the use of brain imaging, the processing of pain is investigated. A central role of the brainstem in stimulus processing was shown with MRI. It is possible that processing at this level dictates whether a stimulus is perceived as painful. Individual variation might determine pain sensitivity.