Irritable Bowel Syndrome: A New ICP Content Page

The Institute for Chronic Pain (ICP) is an educational and public policy think tank that brings together thought leaders from around the world to provide scientifically accurate information about chronic pain and its most effective treatments. We endeavor to provide academic-quality information that is easy to read and as such we serve as a scientifically accurate resource to patients and their families, generalist healthcare providers, third-party payers, and public policy analysts. Our aim is to change the culture of how pain is managed -- to foster a culture in which the field of pain management more readily provides treatments with demonstrated effectiveness.

We imagine a day in which healthcare providers deliver and patients regularly demand empirically-supported therapies for chronic pain. To bring this goal to fruition, stakeholders in the field must have a scientifically accurate source of information on the nature of pain and what most effectively treats it.

What drives pain management today?

Patients and their families are often surprised to learn that not everything that healthcare providers do is effective. Antibiotics for earache and arthroscopic knee surgery are two commonly cited examples of treatments that are routinely provided, but are no better than placebo (which is a common measure of effectiveness). Despite their demonstrated ineffectiveness, these kinds of procedures and therapies continue to be commonly delivered by healthcare providers and demanded by the public for a complex array of reasons.

• Discipline-specific practice: Most healthcare providers do not practice within interdisciplinary teams and so become ignorant of advances made by other disciplines.
• Tradition-bound practice: Healthcare providers tend to practice as they were taught, even if it has been many years since their initial education; keeping up with advances in the field is solely the responsibility of the individual provider and fulfilling this responsibility competes with many other demands on the time of the provider.
• There are few sources of objectively neutral continuing education: Presently, continuing education is predominantly provided by pharmaceutical and medical technology companies, both of which have vested interests in teaching advances that only relate to the sale of their products.
• The profit-motive: In the U.S., the healthcare system is capitalistic and so relies on providers selling a service, under the auspices of making treatment recommendations, and many ineffective procedures and therapies are highly profitable.
• The predominance of the use of placebo-controlled trials of new medications: To come to market, new medications do not have to be more effective than already existing medications for a given condition, but only better than a placebo; as such, with the right marketing strategy, a new medication for a given condition can become a top selling blockbuster, and supplant the use of an already existing medication that happens to be more effective; in other words, the new, but less effective, medication can become more widely prescribed than a more effective older medication that lacks a good marketing strategy.
• A common understanding of a condition that was initially developed based on common-sense considerations can easily remain as a widely-held understanding in society even though empirical research has shown the understanding to be wrong; the reason is that there is no entity responsible for making the more scientifically accurate understanding of the condition more widely known in society.

For any and all these reasons, the healthcare system can continue to provide care that is ineffective or less effective than other therapies and more effective therapies can come to be less commonly used.

Mission of the ICP

Many of the above-noted problems occur because there is no entity that assumes responsibility for both providing up-to-date, scientifically accurate information about health conditions and proliferating this education on a wide scale basis. The goals of the ICP are to engage in these endeavors for issues related to chronic pain. Without any vested professional or financial self-interest, we seek to educate the public and healthcare professionals alike on a) scientifically accurate conceptualizations of the nature of chronic pain conditions and b) how to most effectively treat these conditions.

Irritable Bowel Syndrome

To this end, we announce the publication of a new content page on our website. Written by Jessica Del Pozo, PhD, it provides approachable, yet scientifically accurate, information on irritable bowel syndrome (IBS). IBS is a particularly good example of a condition that society, including many healthcare providers, often misunderstands. Specifically, the commonly held understanding of IBS as a digestive condition isn’t accurate to what we know from science; as a result, in our society, we do not tend to treat it as effectively as we could.

As Dr. Del Pozo indicates, IBS is not primarily a gastrointestinal condition, but rather primarily a nervous system condition. Nonetheless, treatment recommendations are commonly based on the inaccurate understanding of the condition as a gastrointestinal condition. These recommendations fail to be effective and yet they are more commonly pursued. They are even more commonly pursued than therapies focused on the nervous system, which science tells us are more effective.

Our hope is that Dr. Del Pozo's piece on IBS can be one way for society to have access to approachable, yet scientifically accurate, information on the condition. Through this site and our social media, we'll try to proliferate this information.

Your help in this regard would also be greatly appreciated. If IBS is important to you, please link to it on your site or post a link to it through your social media.

Dr. Del Pozo is an expert in the field of chronic pain rehabilitation and in the treatment of IBS in particular. She is the co-author of The Gut Solution, a book for families with IBS utilizing a biopsychosocial approach (www.thegutsolution.com).

Dr. Del Pozo is also the founder of PACE, a four-week chronic pain management program (www.paceforpain.org). In addition, for the last six years, she has been involved in an interdisciplinary chronic pain rehabilitation program at Kaiser Permanente, where she helps people with chronic pain learn to manage their pain without the use of opioid medications.

We appreciate Dr. Del Pozo’s expertise and contribution to the ICP. Please read her important piece on irritable bowel syndrome on the ICP website.

Date of last modification: May 5, 2016

Author: Murray J. McAllister, PsyD