By Maria Adele Giamberardino
Visceral discomfort, or ache within the inner organs, is usually particularly tricky for the clinician to acknowledge quickly as its features are frequently unusual and fluctuate with time. sufferers with visceral ache additionally frequently current with concurrent painful stipulations in additional than one inner organ; this may provide upward thrust to an difficult advanced of signs which are deceptive if no longer competently evaluated. additionally, regardless of its frequency, the mechanisms in the back of discomfort within the inner organs will not be totally understood, and this affects negatively on remedy. This concise pocketbook addresses the epidemiology and medical features of the foremost visceral soreness phenomena, the basics in their neurophysiological mechanisms and the rules in their therapy. It additionally presents overviews of present diagnostic and healing instructions at the stipulations most typically linked to visceral discomfort.
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Extra resources for Visceral Pain: Clinical, Pathophysiological and Therapeutic Aspects
1 The writhing test This alarmingly named test is the oldest model of ‘visceral’ pain and one frequently used for screening of visceral sensitivity. It is based on the intraperitoneal injection of various irritants in conscious rats or mice and the recording of their acute behavioural response, abdominal contractions or ‘writhes’. 1 Sensory characteristics of visceral pain and their related mechanism Psychophysics Neurobiology Not evoked from all viscera Not linked to injury Referred to body wall Diffuse and poorly localised Not all viscera are innervated by “sensory” receptors Functional properties of visceral “sensory” afferents Viscero-somatic convergence in central pain pathways Few “sensory” visceral afferents.
In this chapter we review briefly the various experimental approaches available to study the mechanisms of visceral pain and discuss their relevance to human visceral pain conditions. Visceral pain has clinical features that make it unique and different from somatic pain. 1). 1). Properties (i) and (ii) are due to the functional properties of the peripheral receptors that innervate visceral organs and to the fact that many viscera are innervated by receptors whose activation does not evoke conscious perception and therefore not sensory receptors in a strict sense.
If the affected organ is also inflamed, then visceral hyperalgesia also occurs, and if more than one organ is involved at the same time, viscero-visceral hyperalgesia may take place if these organs have common sensory projections. As a result, the global visceral pain report by a specific patient can be rather complex and its interpretation more difficult. The physician should thus always bear this complexity in mind when facing a clinical situation and systematically consider that what seems the obvious result of one single visceral insult may, instead, be the outcome of several interactions.