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Differentiating Pain from Discomfort: Cognitive Strategies for Eating With GI Disease

With chronic GI diseases, people experience frequent, and sometimes unpredictable, GI symptoms that interfere with life. Often enough, these symptoms are severe, cause significant pain, and require the patient to make substantial alterations to their routine. Especially when these symptoms are severe or unpredictable, the patient is left living in a state of anxiety about when symptoms will strike again or how bad they will be. This leads the patient to fear any GI sensation because it might be the onset of another bad day of GI symptoms. Patients end up avoiding food and have a lot of questions about how to eat with their GI disease.

the word "ouch" written on a paper

This leads to challenges when trialing new foods. New foods often cause new GI sensations. In a situation where any GI sensation is feared as the start of severe symptoms, even mild and benign sensations are catastrophized, leading the person to, understandably, want to avoid any sensation at all. That is a big challenge of eating with a GI disease.

Although this is a great challenge, understanding it this way directs us in how to approach this issue. When working with patients with this history, the first task is to educate patients on how this process works--that their GI disease taught them to recoil from any GI sensation. From there, we work on describing sensations as they occur and differentiating between various sensations. A patient may have a sensation of fullness, noticeable bloating, a feeling of gurgling in their stomach, an urge to defecate, and even a level of discomfort. We can differentiate these noticeable and even uncomfortable sensations with actual pain.

When doing this, we are redefining norms. Every person experiences GI sensations, most of which are not actual pain. When patients can relearn expectations of what are normal and expected GI sensations, they can often work on eating new foods with greater ease. Now they can try new foods and eat better with their GI disease.

A patient might try lentils and have some mild bloating. Before, that was experienced as really bad and necessary to avoid, but now the patient can notice that they are bloated and understand that it will likely get no worse than that noticeable sensation of bloating. Or a patient might eat some watermelon and an hour later need to have a bowel movement. Before that was experienced as the start of severe and urgent diarrhea, but now the patient can experience the urge to defecate, use the bathroom, and understand that the slightly inconvenient experience was no more than an inconvenience.

This cognitive work is best done once the patient's disease is diagnosed, treated, and in remission or under control. This is not a substitute for treating the underlying disease process. Work with a registered dietitian to learn how to differentiate your uncomfortable GI symptoms from pain.

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