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Turn down the volume on IBD-related discomfort

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It is easy to accept discomfort simply as a part of having inflammatory bowel disease.  Discomfort can come in the form of urgency to use the bathroom, abdominal cramping, pain, nausea or fatigue.  But understanding why and how the body creates and processes discomfort can actually change one’s experience of it.

One of my clients recently described to me an episode where she awoke in the night with abdominal pain.  Although the pain was not initially very severe, she kept thinking that something serious might be going on and was worried that this could represent the start of a flare.  She began to focus in on the pain, trying to see whether it would stay or resolve.  She noticed that when she would focus in on the pain, she could feel her body tensing and the pain increased.  This also raised her anxiety level and created a cycle that kept her up for the majority of the night.

Another client told me that she was having anxiety about resuming her commute to work post-pandemic.  She recalled an episode where she had been in a traffic jam. Although she had been feeling fine when she left her house, she began to panic at the thought that she might be stuck in the car for a prolonged time without access to the bathroom.  She experienced a physical response with abdominal cramping and urgency.  But interestingly, as soon as the traffic let up and she knew that she could pull over at any time, her physical symptoms also dissipated.

These examples show how thoughts and feelings can intensify the discomfort associated with IBD.  The second example also demonstrates the power of the mind to resolve discomfort.  Just the thought that my client was no longer stuck allowed her to relax and her physical symptoms went away.

The fact that our thoughts and feelings impact the way that we experience discomfort is amazing news, because it means that we are capable of turning down the volume on our discomfort.

Learning how to harness the power of the mind to reduce pain and discomfort can require some experimentation and practice.  For some of my clients who have lived with discomfort for many years, it can also require an identity shift.  The first step is coming into awareness of the thought patterns and feelings you are experiencing around your discomfort.  Then, we can use techniques that work to diffuse the fear and resistance, reprograming the brain’s response to discomfort.

Of course, it is always important not to ignore pain or a new symptom in IBD, because it could be your body’s way of telling you that something has changed or is wrong.  You should tell your doctor about your symptoms and to have a full evaluation so that the appropriate medical or surgical treatment can keep you well.

To find out more about my exclusive coaching program for women with IBD, contact me.

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The Power of Belief in IBD

In my medical specialty treating inflammatory bowel disease, the placebo effect has been a thorn in the side of doctors. I have called it the placebo “problem.”

In a clinical trial, when we are testing a new medication to see if it will be effective, we compare it to a “placebo” or fake medication (sometimes referred to as a “sugar pill”). The placebo effect occurs when patients receiving the placebo experience a benefit.

My colleagues and I look at the data published in clinical trials and see the clear improvement in patients getting both real drug and placebo as a problem. It makes it hard to interpret their results if many patients are getting better when they are not receiving the real drug. In trials for inflammatory bowel disease, placebo rates for symptom response have historically been between 20-40%. While accounting for the placebo effect is critical to know whether a drug is truly effective, I was ignoring an equally exciting and important part of what these studies show.

Over the past few years, I have begun to look at the placebo response with curiosity and excitement. If patients with Crohn’s disease and ulcerative colitis can objectively feel better by just believing that this is possible, than why are we not harnessing the power of the mind more and learning to do it better? We may not even have to “trick” ourselves into believing we are getting a real medication. Studies have shown that even when people know they are getting a placebo, they may still experience improvement in symptoms.

While there is clearly a very strong mind-body connection in IBD, I think we have to be careful when we recommend harnessing the power of the mind to manage disease. The placebo response as it relates to symptoms is high, but is much lower when we look at more objective markers of inflammation such as blood inflammatory markers (CRP, ESR), stool inflammatory markers (calprotectin) and healing of the tissues seen on colonoscopy. Doctors, including myself, become concerned that patients will take this to mean that they should work on mindset instead of taking traditional medications. We worry that our patients might then suffer long-term complications of undertreating their disease. A better approach is to capture as much benefit as possible using the right medications and the right mindset tools.

In medicine, we often tell patients that they are likely to have a 10-15% response rate to a certain drug. That is what we call the delta- or difference- between the response of the patients who received drug and those who received placebo in a clinical trial. So, for instance, if 20% of subjects receiving placebo responded to a medication and 35% responded to a drug, the drug’s overall efficacy (the difference) is 15%. When I quote these rates of response with medications, my patients often become discouraged at the low likelihood that they will get better. They may not even want to take a chance on a medication that might really work for them. However, when we combine the medication and placebo response, things look much better. The full effect is 35%, not 15%.

So what if I told you that there was something you could do that would make your current medicines twice as effective at reducing your symptoms? What if I also told you it had no traditional medication side effects (unless you count better relationships, increased productivity and less pain)?

I think of the addition of the placebo response to traditional therapy as a starting place. There are then ways that we can train the brain to be even more efficient. Coaching and mindset tools are designed to help us work on believing that getting better is not only possible but inevitable. Then out of that place of determination, we take the actions we need to help the body heal.

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