Pain Questionnaires
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Chronic Abdominal Pain
Introduction
- Abdominal pain is indeed very common
- It frequently derives from disorders of the viscera of the abdominal cavity, followed by referred pain from the chest (Both somatic and visceral nerves of the abdomen and the chest wall cavity share a common segmental distribution within the spinal cord).
Classification
- Abdominal Visceral Disease
- Not all viscera are sensitive to pain : liver, kidney, lung and most solid viscera are not sensitive to pain
- However, expansion of the liver by tumour causing stretch of the liver capsule can be excruciatingly painful
- To be expanded.....
- Musculoskeletal Pain
- Neuropathic Pain
- Other Pain
Viscero-Visceral Hyperalgesia
- Visceral algogenic conditions may affect simultaneously more than one internal organ in the same patient.
- Especially when two viscera are involved which share at least part of their central sensory projection, this circumstance gives rise to the so-called phenomenon of “viscero-visceral hyperalgesia”. In this situation the patient experiences an enhancement of both spontaneous referred pain and referred hyperalgesia (Giamberardino 2000).
- The association of dysmenorrhea with IBS (common projection between uterus and colon: T10-L1) may produce more menstrual pain, intestinal pain and somatic abdominal/pelvic hyperalgesia (in the areas of referral from the uterus and from the intestine) than dysmenorrhea or IBS only.
- Dysmenorrhea/endometriosis combined with urinary calculosis in the same patient (common projection between uterus and upper urinary tract: T10-L1) has been shown to produce increased menstrual pain, urinary colic pain and somatic abdomino-pelvic/lumbar hyperalgesia (in the areas of referred pain from the uterus and from the urinary tract), with respect to one condition only (Giamberardino 2001).
- This "viscero-visceral hyperalgesia” has important therapeutic implications. Effective treatment of one condition may significantly improve symptoms from the other (e.g. decrease in urinary pain and referred hyperalgesia at lumbar level after hormonal treatment of dysmenorrhea or decrease in menstrual pain and referred abdomino-pelvic hyperalgesia after urinary stone elimination following lithotripsy) (Giamberardino 2000, 2001).
Management
- To be expanded
Web Links
References
- Giamberardino MA. Visceral Hyperalgesia. In: M Devor, MCRowbotham, Z Wiesenfeld-Hallin (Eds.), Progress in Pain Reseach and Managemen, Vol. 16. Seattle: IASP Press, 2000. pp. 523-550.
- Giamberardino MA, De Laurentis S, Affaitati G, Lerza R, Lapenna D, Vecchiet L. Modulation of pain and hyperalgesia from the urinary tract by algogenic conditions of the reproductive organs in women. Neurosci Lett 2001; 304: 61-64.