Evidence for the Presence of a Visceral Pain Pathway in the Dorsal Column of the Spinal Cord
Mark J Rowe, Yoshiaki Iwamura in Somatosensory Processing: From Single Neuron to Brain Imaging, 2001
Investigation of the dorsal column visceral pain pathway was extended to monkeys to ensure that evidence like that obtained in rats could be obtained in a species whose nervous system closely resembles that of humans. Long ascending axons in the dorsal column of the mammalian spinal cord are generally thought to arise either from dorsal root ganglion cells or from neurons whose cell bodies are located in the gray matter of the dorsal horn. In order to determine the brain structures that are affected by colorectal distention and the changes that might occur following a lesion of the dorsal column, a functional magnetic resonance imaging study was initiated. Clinical evidence indicates that the human dorsal column contains an important visceral pain pathway that, when interrupted, can relieve the pain of cancer affecting pelvic viscera. The dorsal column also mediates responses to weak mechanical stimulation of the skin.
Abdomen
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
The term acute abdomen refers to an intra-abdominal condition, which usually requires a surgical intervention, such as appendicitis. Visceral pain originating from the foregut is typically felt in the epigastric area; pain originating from the midgut is typically felt in the peri-umbilical area; and pain originating from the hindgut is typically felt in the lower abdomen. A young child is best examined in a parent's arms or lap. Distracting the child while palpating the abdomen is very helpful. A student or postgraduate doctor in an examination who hurts the child while examining the abdomen should expect to fail. Children with Mesenteric adenitis (MA) may present with acute abdominal pain in the lower quadrant of the abdomen mimicking appendicitis, but pain is more diffuse in MA. Children typically have a longer history of pain, greater systemic effect, high fever, more generalized tenderness and absent bowel sounds.
Pelvic Pain
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
All women will at some time experience pelvic pain associated with events such as menstruation, ovulation, or sexual intercourse. Pelvic pain may be either visceral or somatic in origin. Visceral pain is transmitted by the autonomic nervous system and presents as a vague, deep, dull sensation that is difficult to localise and may even present as referred pain. Somatic pain on the other hand is usually constant with sharp periods of exacerbation and is well localised over the affected area. The differential diagnosis of pain in the pelvis can be subdivided as follows: acute; subacute; and chronic. Any acute cause of pain, even with appropriate initial management, may lead on to a chronic condition. A history of episodes of acute pelvic pain, increased number of sexual partners, and a higher incidence of psychosexual trauma as a child may be present.
Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome
Published in Gut Microbes, 2014
Vassilia Theodorou, Afifa Ait-Belgnaoui, Simona Agostini, Helene Eutamene
The last ten years’ wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient’s quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation.
Chronic abdominal pain in irritable bowel syndrome – current and future therapies
Published in Expert Review of Clinical Pharmacology, 2018
Anna Zielińska, Maciej Sałaga, Marcin Włodarczyk, Jakub Fichna
Introduction: Irritable bowel syndrome (IBS) is a functional gut disorder that typically manifests in early adult years. One of the two major symptoms of the disease is chronic, visceral pain. The patients report pain as the most distressing symptom with the greatest impact on quality of life, challenging both to patients and healthcare providers. Areas covered: This review focuses on the pathophysiology of abdominal pain in IBS and describes current treatment possibilities. It also covers latest findings that may lead to novel pharmacological options in IBS pain management. Expert commentary: Pain is the main contributor to severity in IBS. Seeking pain alleviation is the most common reason that IBS sufferers consult with their physicians. Not all patients report being satisfied with available treatments for pain in IBS and there is a pressing need to find new, more efficient therapies for this syndrome.
A New Paradigm in Chronic Bladder Pain
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2014
The concept of visceral pain has moved from organ-centered disease to a conceptualization based on pathophysiological mechanisms, integrating psychosocial and sexual dimensions. The terms painful bladder syndrome and bladder pain syndrome have been coined to include all patients with bladder pain. There is substantial overlap between IC/BPS and other pelvic/abdominal pain syndromes IC/BPS is likely to be underdiagnosed and undertreated in both men and women IC/BPS requires a multidisciplinary team approach toward management. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
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