Visceral Pain: Basic Research Concepts and Therapeutic Interventions
Victor V. Chaban
DOI : 10.3844/ijrnsp.2015.27.28
International Journal of Research in Nursing
Volume 6, Issue 2
The accumulation ofnociceptive diseases that limit normal body functions is a major risk factorfor a disability, and visceral pain is one of the most prevalent human healthproblems. Additionally, many pain-associated diseases are accompanied by theconcomitant decline in cognitive and motor performance. The complex interplayand balance between diverse signal transduction mediators, genetic backgroundand environmental factors may ultimately determine the outcome of nociceptiveprogression in various disorders. Pain is a subjective feeling that isdifficult to standardize and parameterize in a traditional fashion forscientific analysis. The causes of visceral pain are often not very clear, asthere are many symptoms of the reproductive, gastrointestinal, musculoskeletal,neurological, psychological systems and urinary tract that often co-occur inthe same patient. VIscero-somatic and viscero-viseral hyperalgesia andallodynia Cause the perception of pain to spread for an initial area, toadjacent visceral sites (Pan and Malykhina, 2014). Often times, there is not aclear relationship between the severity. There is often no clear relationshipbetween the severity of the visceral pain and pathology in the viscera,including the reproductive tract, urinary bladder and colon. The cliniciantreating this pain is often times tempted to adopt a unidimensional approach,focusing on one organ system, ignoring the psychological and behavioralmanifestations of the visceral pain. Therefore, studies of the nervous systemin individuals with visceral pain associated with reproduction such as ChronicPelvic Pain (CPP) syndrome, urinary system such as Painful Bladder Syndrome (PBS)and bowel disorders such as Irritable Bowel Syndrome (IBS), suggest a model inwhich alteration in the central stress circuits in predisposed individuals maytrigger and then maintain, the pain and pathophysiological changes in theviscera (Mayer, 2011). These patients have significantly more depression,psychological and somatic complains and more often give a history of physical,sexual or emotional abuse, or trauma. Chronic visceral pain results in adverseaffects not only one’s mood, but also their professional and social lives, aswell as general well-being;; the quality of life issues can affect the severityof pain, degree of impairment resulting from a painful condition and success oftreatment modalities in alleviating pain.
Pain accounts for a majority of all primary health carevisits. For the past decade, medical literature has carefully documented theunder-treatment of all types of pain by physicians. Pain is a complex andindividual experience that is often difficult for patients to fullydescribe using a conventional clinical assessment (Meltzak, 2001). Visceral pain affects up to 25% of women at sometime in their lives (about a billion worldwide) and can result in dysmenorrhea,dyspareunia, menstrual irregularities, back pain, gastrointestinal andgenitourinary symptoms and reduced fecundity. The incidents of persistentvisceral pain associated with functional disorders such as IBS, CPP, PBS andothers is 2-3 times higher in women than in men, suggesting estrogenmodulation. In women, pain symptoms and nociceptive thresholds vary withreproductive cycle and our previous data strongly suggest the role of estrogenreceptors in modulating of nociceptive signaling (Chaban et al., 2011; Cho and Chaban, 2012; Chaban, 2012; 2014).
There are two essential components of pain: discriminative and affective.The discriminative component includes the ability to identify the stimulus asoriginating from somatic or visceral tissue, determine some of the physicalproperties of the stimulus and localize it in space, time and along a continuumof intensities. The affective component is the experience which motivatesescape, avoidance and protective behavior. All of these components of pain mustbe considered in any discussion of the neurophysiological basis of visceralpain. Because of the inherent subjectivity of pain, there is a wide disparityamong individuals in the way that they experience pain generated by what seemto be similar stimuli. There is also a tension between the subjectivity of thepatient’s pain experience and the common insistence of the clinician uponobjective findings that are proportionate with the patient’s complaints, toenable to distinguish between exaggerated pain reports. Proposed therapeuticconsiderations must also include the neural systems modulating pain, for it iswell known that pain can be profoundly influenced by other somatic stimuli andby attentional, emotional and cognitive factors. Careful history andphysical examination are crucial in evaluating a suffering patient and mustaddress all of the possible systems potentially involved in visceralpain.
An important focus of clinical management now includesthe assessment of pain on various aspects of a patient’s existence. Thehealth-related quality of life that encompasses Health related qualities oflife are comprised of aspects of health and well-being that are valued bypatients, such as their emotional, physical, and cognitive state, and ability to participate in meaningful tasks. Thereis a concern that not enough emphasis is placed on a clinical validity (i.e.issues which are important to patients and reflect their experiences). Abalance between biomedical, organ-oriented and cognitive interpersonalapproaches is the most appropriate to study this psychosomatic interface. Inview of the iatrogenic component in the maintenance of painful syndromes,clinician-centered interventions and close observation of the clinician-patient relationship are ofparticular importance. Nociceptive responses involve a vast number of messengermolecules that interact with enzymes and receptors of all classes. They directthe recruitment of different types of cells to assist in the recovery of ahealth state. A balance between these messengers and the redundancy of variousbody systems presents major difficulties for therapeutic intervention.Nevertheless, it is a very important aspect to consider in the treatment ofdisorders association with visceral pain.
This work is supported by NationalInstitute of Minority Health and Health Disparities (NIMHD) of NationalInstitute of Health under award numbers: S21 MD 000103 and U54 MD 007598.
EthicsThere are no ethical issuesassociated with this publication.
© 2015 Victor V. Chaban. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.