IBS Part 3: Pain

Another key aspect of IBS that was mentioned earlier is the fact that its principle distinguishing feature is pain. As such, it only seems appropriate to take a closer look at the nature of this sensation—particularly because it differs from all other sensations that we experience as a species.

Normally, when we experience a sensation, we acclimate to that sensation and eventually forget that it is there. To give a very immediate example, think about the clothing that you are wearing. When you put it on this morning, your sense of touch made you aware of how it felt making contact with your skin, how it fell on your body, and whether or not you needed to make any arrangements so that it might not be uncomfortable throughout the day. Chances are, up until now you probably had forgotten about the sensation felt earlier in the day, and were not even consciously aware of wearing anything. The same thing goes for smell, taste, sound, and sight (although this last one could be argued to pertain to peripheral and not central vision, but that’s a discussion for another time).

One of the key differences between these other five sensations and pain, is that pain is the one sensation that you cannot become desensitized to over time. Rather, it can become worse the more chronic it is. Pain is a completely subjective experience that has no way to measure it objectively. As such, pain tolerances depend upon many factors, including emotional state, constitution, and expectation of the pain that could be experienced. A pain scale will always be subjective, with each person’s maximum level of 10 varying from something as simple as a 1 centimeter cut on a finger, to a life-threatening gunshot wound.

“Pain is an experience that occurs not only from physical damage but also when your brain predicts damage is imminent.” (Lisa Feldman Barrett. How emotions are made: The secret life of the brain. Boston, MA: Houghton Mifflin Harcourt, 2017.) Our brains are complex organs that scientists are constantly learning about. One of many details that they are discovering is that our brains adapt to the world that they receive input from and predict what may occur so that they may better react to what is occurring. When it comes to pain, however, this can be detrimental. Over time, there have been many definitions of what pain is (including the quote above), but they all point to similar factors:

  1. Pain is a subjective experience that cannot be tested objectively, as with a blood test.

  2. How one experiences pain is based in one’s previous experiences of it, meaning that it is also learned.

  3. It is usually associated with a negative experience.

As such, this prediction of pain to be experienced can make the sensation that is felt worse. In fact, the brain may perceive the sensation of what we call pain before any sensation is actually felt, thereby falling into the category of what is called the nocebo effect. In the context of medicine and clinical practice, “a nocebo response is a negative symptom induced by the patient’s own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment.”


Lisa Feldman Barrett. How emotions are made: The secret life of the brain. Boston, MA: Houghton Mifflin Harcourt, 2017.) Please visit Amazon.com to purchase this book.

Cohen, Miltona; Quintner, Johnb; van Rysewyk, Simonc Reconsidering the International Association for the Study of Pain definition of pain, PAIN Reports: March/April 2018 – Volume 3 – Issue 2 – p e634. Please visit this website to read more: doi: 10.1097/PR9.0000000000000634.

Häuser, Winfried et al. “Nocebo phenomena in medicine: their relevance in everyday clinical practice.” Deutsches Arzteblatt international vol. 109,26 (2012): 459-65. Please visit this website to read more: doi:10.3238/arztebl.2012.0459

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