Visceral Pain: From Bench to Bedside

✍ Scribed by Ming Xia, Bifa Fan, Hong Jiang

• Publisher: 9819991668
• Year: 2024
• Tongue: English
• Leaves: 326
• Category: Library

✦ Table of Contents

Contents
Contributors
Editors
Associate Editors
1: Introduction
1.1 An Overview of Visceral Pain
1.1.1 Concept of Pain
1.1.2 Classification of Pain
1.2 Concept and Classification of Visceral Pain
1.3 Clinical Features of Visceral Pain
1.3.1 Clinical Visceral Pain
1.3.2 Specific Types of Visceral Pain or Abdominal Pain Syndrome
1.4 Summary
References
2: Anatomy of the Visceral Nerves
2.1 Visceral Motor Nerves
2.1.1 Differences Between Visceral Motor Nerves and Somatic Motor Nerves
2.1.2 Sympathetic Nerve Anatomy
2.1.3 Anatomy of Parasympathetic Nerves
2.1.4 Main Differences Between Sympathetic and Parasympathetic Nerves
2.1.5 Visceral Plexus
2.1.6 The Enteric Nervous System
2.2 Visceral Sensory Nerves
2.2.1 Characteristics of Visceral Sensory Nerves
2.2.2 Endoreceptors
2.2.3 Visceral Sensory Nerve Conduction Pathway
2.2.4 Referred Pain
References
3: Physiological Mechanisms of Visceral Pain
3.1 Introduction
3.2 Visceral Sensory Nerves
3.3 Physiological Features of Visceral Pain
3.4 Visceral Nociception
3.4.1 Noxious Visceral Stimuli
3.5 Visceral Afferent Fibers
3.5.1 Vagal Afferents
3.5.2 Spinal Afferents
3.6 Mechanisms of Visceral Pain
3.6.1 Peripheral Mechanisms of Visceral Pain Production
3.6.2 Central Processing of Visceral Pain
3.7 Summary
References
4: Pathophysiological Mechanisms of Visceral Pain
4.1 Etiology of Visceral Pain
4.1.1 Chest Visceral Pain
4.1.1.1 Respiratory Organ Diseases
4.1.1.2 Circulatory Organ Diseases
4.1.1.3 Esophageal Disease
4.1.1.4 Referred Chest Pain Caused by Abdominal Visceral Pain
4.1.1.5 Others
4.1.2 Abdominal Visceral Pain
4.1.2.1 Pain of Gastrointestinal Diseases
4.1.2.2 Pain in Pancreatic Diseases
4.1.2.3 Pain of Hepatobiliary Diseases
4.1.2.4 Pain of Urinary System Diseases
4.1.2.5 Pain of Retroperitoneal Disease
4.1.2.6 Pain of Vascular Disease
4.1.2.7 Abdominal Pain of Spinal Origin
4.1.2.8 Functional Abdominal Pain Syndrome
4.1.3 Gynecological and Obstetric Internal Pain
4.1.3.1 Labor Pains
4.1.3.2 Dysmenorrhea
4.1.3.3 Supernumerary Ovary
4.1.3.4 Adenomyosis of the Uterus
4.1.3.5 Adhesions
4.1.3.6 Adnexal Cysts
4.1.3.7 Endometriosis
4.1.3.8 Smooth Muscle Tumor
4.1.3.9 Preserved Ovary Syndrome
4.1.3.10 Pelvic Stasis Syndrome
4.1.3.11 Peritoneal Cysts
4.1.3.12 Symptomatic Pelvic Relaxation Disorder
4.1.3.13 Other
4.1.4 Cancer Pain
4.1.4.1 Pain Caused by Cancer Development
4.1.4.2 Pain Caused by Cancer Treatment
4.1.4.3 Cancer Pain Syndrome
4.2 Conduction of Visceral Pain
4.2.1 Visceral Pain Receptors
4.2.1.1 General Concept and Characteristics of Receptors
4.2.1.2 Characteristics of Visceral Pain Receptors
4.2.1.3 Injurious Stimuli and the Transduction of Injurious Receptors
4.2.2 Visceral Pain Afferent to Nerve Fibers
4.2.2.1 Visceral Pain Afferent Fibers
4.2.2.2 Differences Between Visceral Pain Afferent Fibers and Somatic Pain Afferent Fibers
4.2.2.3 Visceral Sensory Nerves
4.2.2.4 Excitability of Visceral Afferent Neurons
4.2.3 Visceral Pain Conduction Pathway
4.2.3.1 Synapse-Mediated Conduction Mechanism
4.2.3.2 Conduction Pathways
4.2.4 Characteristics of the Visceral Pain Centers and Their Information Transmission
4.2.4.1 Subcortical Centers
4.2.4.2 Higher Centers
4.2.4.3 Characteristics of Visceral Information Central Transmission
4.3 Perception and Regulation of Visceral Pain
4.3.1 Feeling Characteristics of Different Organs
4.3.2 Central Sensory Characteristics
4.3.2.1 Performance of Pain Conduction Tracts
4.3.2.2 Performance of Subcortical Centers
4.3.2.3 Performance of Higher Centers
4.3.3 Regulatory Mechanisms of Visceral Pain
4.3.3.1 Feedback Regulation of Receptors
4.3.3.2 Inter-synaptic Inhibition
4.3.3.3 Convergence
4.3.3.4 Multisynaptic Transmission
4.3.4 Modulation of Nociception by the Central Nervous System at All Levels
4.3.4.1 Cortical Modulation
4.3.4.2 Modulation of the Mesencephalon
4.3.4.3 Modulation of the Brainstem
4.3.4.4 Modulation of the Spinal Cord
4.3.5 Nociceptive Hypersensitivity
4.3.5.1 Peripheral and Central Mechanisms of Pain Sensitization
4.3.5.2 Generation of Central Sensitization
4.3.5.3 Primary and Secondary Nociceptive Hypersensitivity
4.3.5.4 Hyperalgesia Due to Psychological Factors
4.4 Pathophysiological Mechanisms of Visceral Pain
4.4.1 Neurophysiological Mechanisms of Visceral Pain
4.4.2 Endogenous Biochemical Mechanisms of Visceral Pain
4.4.3 Psychological Mechanisms of Visceral Pain
4.4.4 Mechanism of Referred Pain
4.4.4.1 Nerve Convergence
4.4.4.2 Convergence-Facilitation
4.4.4.3 Gate Mechanism
4.4.4.4 Convergence-Projection
4.4.4.5 Axonal Reflex Theory
References
5: Evaluation and Examination of Visceral Pain
5.1 Introduction
5.2 Assessment of Visceral Pain in Animal Models
5.2.1 Recording of Abdominal Muscle Contraction
5.2.2 Histological Analysis
5.2.3 Electrophysiology of Nerve Bundles or a Neuron
5.2.4 Response of the Model to Drug Disposition
5.3 Assessment of Visceral Pain in Humans
5.3.1 Principles of Pain Assessment
5.3.2 Pain Evaluation Approach
5.3.3 Determination of Location of Pain
5.3.4 Commonly Used Self-Report and Behavioral Analysis Methods for Evaluating Pain Level
5.4 Special Features of Visceral Pain Assessment
5.4.1 True Visceral Pain and Pseudovisceral Pain
5.4.2 Visceral Referred Pain
5.5 Initial Diagnosis of Visceral Pain
5.5.1 Medical History
5.5.2 Physical Examination
5.6 Diagnostic Testing
5.7 Summary
References
6: Medication Treatment for Visceral Pain
6.1 Current Status of Pharmacological Treatment of Visceral Pain and Commonly Used Drugs
6.2 Current Medications for Visceral Pain
6.2.1 Opioids
6.2.1.1 κ-Opioid Receptor Drugs
6.2.1.2 μ-Opioid Receptor Class of Drugs
6.2.1.3 κ, μ Double Receptor Drugs: Oxycodone Hydrochloride
6.2.2 Non-opioid Drugs
6.2.2.1 NSAID
6.2.2.2 Beneficial Intestinal Bacteria
6.2.2.3 Corticotropin-Releasing Factor Receptor-1 (CRF1R) Antagonists
6.2.2.4 Pregabalin
6.2.2.5 TRP Ion Channel Orange Resistance Drug
6.3 Combination Therapy
6.4 Summary
References
7: Neuromodulation Therapy for Visceral Pain
7.1 Nerve Block or Neurolysis
7.1.1 Abdominal Plexus or Visceral Nerve Block/Neurolysis
7.1.2 Superior Hypogastric Plexus Block
7.1.3 Inferior Hypogastric Plexus Block
7.1.4 Ganglion Impar Block
7.1.5 Intraspinal Infusion
7.2 Neuroelectrical Stimulation Techniques
7.2.1 Gastrointestinal Electrical Stimulation Techniques and Gastrointestinal Tract Movement Disorders
7.2.2 Spinal Cord Stimulation (SCS)
7.2.3 Peripheral Nerve Electrical Stimulation
7.2.4 Transcutaneous Electrical Nerve Stimulation
7.2.5 Non-invasive In Vitro Neuromodulation
7.2.6 Motor Cortex Stimulation
7.2.7 Deep Brain Stimulation
7.2.8 Non-invasive Transcranial Stimulation
References
8: Traditional Chinese Medicine for Visceral Pain
8.1 Introduction
8.1.1 Pathogenesis and Etiology of Visceral Pain
8.1.2 Classification of Visceral Pain
8.2 TCM for Visceral Cancer Pain
8.2.1 Perception of Visceral Cancer Pain in TCM
8.2.2 TCM in the Treatment of Visceral Cancer Pain
8.2.2.1 Internal Treatment Methods
8.2.2.2 External Treatment Methods
8.2.2.3 A Combination of Internal and External Treatment Methods
8.2.3 Integration and Complementation of TCM with Western Medicine Treatments
8.2.3.1 Opioid-Induced Constipation
8.2.3.2 Combination of TCM and Three-Step Analgesic Ladder
8.2.3.3 TCM in Three-Step Analgesic Ladder
8.2.3.4 TCM for Cancer Pain Relief
8.2.3.5 TCM with Chemotherapy
8.2.3.6 TCM with Radiotherapy
8.2.4 TCM Five-Element Emotional Therapy in Visceral Pain
8.2.4.1 Music Delighting Emotions
8.2.4.2 Following Desires with Understanding
8.2.4.3 Comfort and Uplift Emotions
8.2.4.4 Providing Comfortable Environment
8.2.4.5 Exchanging Feelings and Experience
8.2.4.6 Elimination of Psychogenic Factors
8.2.4.7 Suggestion Therapy
8.2.4.8 Overcoming One Emotion by Another Emotion
8.2.4.9 Emotion Activation Method
8.3 TCM in Noncancer Visceral Pain
8.3.1 Functional Abdominal Pain Syndrome
8.3.1.1 Spleen and Stomach Weakness Type
8.3.1.2 Liver Depression and Qi Stagnation Type
8.3.1.3 Cold Accumulation and Qi Stagnation Type
8.3.1.4 Indigestion and Heat Accumulation Type
8.3.1.5 Summary
8.3.2 Biliary Colic
8.3.3 Chronic Pancreatitis Pain
8.3.3.1 Treatment Based on Syndrome Differentiation
8.3.3.2 Precautions
8.3.4 Stomach Pain
8.3.5 Irritable Bowel Syndrome
8.3.5.1 External Treatment Methods in TCM Ancient Classics
8.3.5.2 Clinical External Treatment Methods of TCM
8.3.5.3 Summary
8.3.6 Chronic Pelvic Inflammatory Disease
8.3.7 Dysmenorrhea
8.3.7.1 TCM Treatment
8.3.7.2 Acupuncture Therapy
8.3.7.3 Massage Therapy
8.3.7.4 Moxibustion Therapy
8.3.7.5 Acupoint Injection Therapy
8.3.7.6 Auricular Point Pressing Therapy
8.3.7.7 Other Treatments
8.3.7.8 Summary
8.3.8 Testicular Pain
8.3.9 Interstitial Cystitis
8.3.9.1 Etiology and Pathogenesis of Interstitial Cystitis [26]
8.3.9.2 Prescriptions for Treating Interstitial Cystitis
8.3.9.3 Summary
8.3.10 Ulcerative Colitis
8.3.10.1 Etiology and Pathogenesis
8.3.10.2 Treatment Based on Syndrome Differentiation
8.3.10.3 Treatment Methods
8.3.10.4 Summary
8.3.11 Chronic Pelvic Pain Syndrome
8.3.11.1 Etiology and Pathogenesis
8.3.11.2 TCM Internal Treatment
8.3.11.3 TCM External Application
8.3.11.4 Acupuncture
8.3.11.5 TCM Retention Enema
8.3.11.6 Summary
8.3.12 Postoperative Pain
8.3.12.1 Prostate-Related Postoperative Pain
8.3.12.2 TCM External Treatment
8.3.12.3 TCM Internal Treatment
8.4 Summary
References
9: Other Treatments for Visceral Pain
9.1 Surgical Treatment
9.1.1 Anterolateral Cordotomy
9.1.2 Dorsal Root Entry Zone Dissection
9.1.3 Anterior Commissurotomy
9.1.4 Posterior Median Spinal Cord Punctal Dissection
9.2 Psychological Treatment
9.2.1 Relaxation Therapy
9.2.2 Biofeedback
9.2.3 Hypnotherapy
9.2.4 Psychological Counseling
9.2.5 Mind–Body Intervention
9.2.6 Multidisciplinary Integrated Therapy
References
10: Chest Pain
10.1 Introduction
10.2 Causes of Acute Chest Pain
10.2.1 Myocardial Ischemia (MI)
The most common cause of acute chest discomfort is
10.2.2 Pericardial Disease
10.2.3 Vascular Disease
10.2.4 Pulmonary Disease
10.2.5 Gastrointestinal Disorders
10.2.6 Musculoskeletal and Other Causes
10.3 Classifications of Chest Pain
10.3.1 Noncardiac Chest Pain (NCCP)
10.3.1.1 Etiologies of NCCP
10.3.1.2 Evaluation of NCCP
10.3.1.3 Summary
10.3.2 Cardiac Chest Pain
10.4 Clinical Assessment
10.5 Assessment and Diagnostic Testing
10.5.1 Medical History
10.5.2 Physical Examination
10.5.3 Electrocardiography
10.5.4 Chest Radiography
10.5.5 Biomarkers
10.5.6 HEART Score
10.5.7 Conclusion
10.6 Treatments
10.6.1 Acute Coronary Syndrome (ACS)
10.6.2 Pneumothorax (PTX)
10.6.3 Pericardial Tamponade
10.6.4 Aortic Dissection
10.6.5 Esophageal Perforation
10.6.6 Gastrointestinal Reflux Disease (GERD)
10.6.7 Pulmonary Embolism (PE)
10.6.8 Costochondritis
10.6.9 Generalized Anxiety Disorder (GAD)
10.6.10 Cognitive Therapy
References
11: Pain in Abdominal Viscera
11.1 Abdominal Pain in Irritable Bowel Syndrome
11.1.1 Definition and Classification of Irritable Bowel Syndrome
11.1.2 The Etiology and Pathogenesis of Abdominal Pain in Irritable Bowel Syndrome
11.1.3 Diagnosis and Treatment of Abdominal Pain and Irritable Bowel Syndrome
1. Diagnosis
2. Treatment
(a) Health education
(b) Dietary treatment
(c) Antispasmodics
11.2 Peptic Gastric Ulcer
11.2.1 Possible Pathogenesis of Peptic Ulcer Pain
11.2.2 Peptic Ulcer Abdominal Pain Site and Characteristics
pain is often located in
pyloric ulcers are mostly located in
duodenal ulcers are mostly located in
can be radiated to
Ulcer disease pain may present as
The intensity of pain is
When the ulcer is combined with pyloric obstruction, the abdominal pain may become
11.2.3 Treatment of Peptic Ulcer Pain
11.3 Chronic Pancreatitis and Pain Due to Its Acute Attacks
11.3.1 Definition, Epidemiology, and Classification of Chronic Pancreatitis
11.3.2 Chronic Pancreatitis and Pain
11.3.3 Mechanisms of the Occurrence of Pain in Chronic Pancreatitis
11.3.4 Treatment of Chronic Pancreatitis Pain
11.3.4.1 Medical Treatment
11.3.4.2 Endoscopic Treatment
11.3.4.3 Surgical Treatment
11.3.4.4 Comparative Control Study of Surgical and Endoscopic Treatment
11.4 Biliary Dyskinesia
11.4.1 Overview
11.4.2 Possible Mechanisms of Biliary Dyskinesia
11.4.3 Diagnosis, Examination, and Treatment of Biliary Dyskinesia
11.4.3.1 Diagnosis and Examination of Biliary Dyskinesia
11.4.3.2 Treatment of Functional (Non-stone) Biliary Pain
11.4.4 Diagnosis, Examination, and Treatment of Biliary Dyskinesia After Cholecystectomy
11.4.4.1 Diagnosis and Examination of Biliary Dyskinesia After Cholecystectomy
11.4.4.2 Causes of Functional Biliary Pain After Cholecystectomy
11.4.4.3 Clinical Treatment of Functional Biliary Pain After Cholecystectomy
11.5 Visceral Pain Due to Surgery (Abdominal Adhesions)
11.5.1 Overview
11.5.2 Pathophysiology of Adhesive Pain
11.5.2.1 Pathogenesis of Abdominal Adhesions
11.5.2.2 Factors in the Development of Adhesive Pain
11.5.2.3 Differential Diagnosis of Abdominal Wall Pain
11.5.3 Treatment of Visceral Pain with Abdominal Adhesions
11.5.3.1 Diagnostic Treatment
11.5.3.2 Treatment of Pain Due to Visceral Factors
11.5.3.3 Treatment of Abdominal Wall Pain
11.5.3.4 Other Treatment Methods
11.5.4 Prevention Strategies for Abdominal Adhesions
11.5.4.1 Barrier Prevention and Control
11.5.4.2 Drug Prevention and Control
11.5.5 Summary
11.6 Common Pediatric Recurrent Abdominal Pain
11.6.1 Overview
11.6.2 Etiology, Diagnosis, and Treatment of Organic RAP
11.6.2.1 Etiology
11.6.2.2 Diagnosis and Differential Diagnosis
11.6.2.3 Treatment of Organic RAP
11.6.3 Etiology, Diagnosis, and Treatment of Functional RAP
11.6.3.1 Etiology and Diagnosis
11.6.3.2 Treatment of Functional RAP
11.6.3.3 Prognosis of Functional RAP
11.6.4 Perioperative Abdominal Pain in Children
11.6.5 Summary
References
12: Chronic Abdominal Pain Due to Obstetric and Gynecological Factors
12.1 Introduction
12.2 Definition of CPP
12.3 Prevalence of CPP
12.4 Pelvic Anatomy and Pathogenesis of CPP
12.4.1 Pelvic Anatomy
12.4.1.1 Innervation of Female Genital Organs
12.4.1.2 Function of Nerves in Female Genital Organs
Sensory Nerve
Motor Nerve
12.4.2 Pathogenesis of CPP
12.4.2.1 Common CPP-Related Syndromes
Endometriosis
Adenomyosis
Hydrosalpinx
Pelvic Inflammatory Disease (PID)
Pelvic Congestion
Dysmenorrhea
Vulvodynia or Vestibulodynia
12.5 Diagnostic Ideas for CPP in Women
12.5.1 Medical History
12.5.2 Physical Examination
12.5.3 Laboratory Tests and Imaging
12.5.3.1 Laboratory Tests
12.5.3.2 Ultrasound
12.5.3.3 Pelvic Venography
12.5.3.4 Laparoscopy
12.6 Treatments for CPP
12.6.1 Treatments for Endometriosis
12.6.2 Treatment for Dysmenorrhea
12.7 Summary
References
13: Visceral Pain and Pelvic Pain Related to Urogenital System
13.1 Introduction
13.2 Definition of Chronic Pelvic Pain
13.3 Mechanisms of CPP
13.3.1 Central Sensitization
13.3.2 Mechanisms of Spinal Cord and Visceral Hyperalgesia
13.3.3 Advanced Central Modulation of Nociceptive Pathways in Spinal Cord
13.3.4 Emotional, Cognitive, Behavioral, and Sexual Response Mechanisms
13.3.4.1 Neuromodulation and Psychology
13.3.4.2 Autonomic Nervous System
13.3.5 Other Mechanisms
13.3.5.1 Endocrine System
13.3.5.2 Genetics and Chronic Pelvic Pain
13.4 Classification of Chronic Pelvic Pain
13.4.1 Guidelines for the Classification of Chronic Pelvic Pain Syndrome
13.4.2 Classification of Common Chronic Pelvic Pain [11]
13.5 Urogenital/Pelvic Pain in Men
13.5.1 Mechanism of Urogenital/Pelvic Pain in Men
13.5.1.1 Innervation and Pelvic Floor Structure of Pelvis
13.5.1.2 Key Role of the Central Nervous System in Persistent Pain
13.5.2 Clinical Manifestations
13.5.2.1 Abnormal Urinary Function
13.5.2.2 Abnormality of Urodynamics
13.5.2.3 Hypersensitivity of Genitourinary System
13.5.3 Treatment
13.6 Common Male Pelvic Pain Syndromes
13.6.1 Primary Prostate Pain Syndrome
13.6.1.1 Pathogenesis
Theories of Spastic Pain in Pelvic Floor Muscle Groups
Theory of Neurogenic Inflammation
Cytokines Theory
Mechanism of Referred Pain
13.6.1.2 Clinical Manifestation
13.6.1.3 Diagnosis
13.6.1.4 Differential Diagnosis
13.6.1.5 Treatment
13.6.2 Bladder Pain Syndrome/Interstitial Cystitis
13.6.2.1 Definition and Overview
13.6.2.2 Etiology and Pathophysiology
13.6.2.3 Diagnosis
13.6.2.4 Treatment
13.6.3 Scrotal Pain Syndrome
13.6.3.1 Diagnosis
13.6.3.2 Treatment
13.6.4 Urethral Pain Syndrome
References
14: Visceral Cancer Pain
14.1 Causes of Visceral Cancer Pain and its Clinical Manifestations
14.2 Current Treatment of Cancer Pain
14.3 Perineural Infiltration and Visceral Cancer Pain
14.3.1 Perineural Infiltration of Tumors
14.3.2 Molecular Mechanisms of Peripheral Nerve Infiltration
14.3.3 PNI and Pain Production in PDA
14.3.4 Treatment Strategies for PN and Pain
14.4 Pharmacological Treatment of Visceral Cancer Pain
14.4.1 Opioids
14.4.1.1 Routes of Drug Administration
14.4.1.2 Precautions for Clinical Application of Opioids
14.4.2 Nonsteroidal Anti-Inflammatory Drugs
14.4.3 Anticonvulsant Drugs and Antidepressants
14.5 Minimally Invasive Treatment of Visceral Cancer Pain
14.5.1 Nerve Block/Destruction
14.5.1.1 Neurolytic Celiac Plexus Block
14.5.1.2 Superior Hypogastric Plexus Block
14.5.1.3 Ganglion Impar Block
14.5.2 Intrathecal Analgesia
14.5.2.1 Intrathecal Analgesic Drug Treatment
14.6 Summary
References
15: New Technologies and Prospects in the Treatment of Visceral Pain
15.1 Progress in Medical Treatment of Visceral Pain
15.1.1 Adjuvant Drug Therapy
15.1.1.1 GABA Analogues
15.1.1.2 Antispasmodics
15.1.1.3 Antidepressants
15.1.2 Unconventional Treatment
15.1.2.1 TRPV1 Receptor Antagonist
15.1.2.2 Ketamine
15.1.2.3 Anti-NGF Monoclonal Antibody
15.1.2.4 Linaclotide
15.1.2.5 Other Unconventional Drugs
15.2 Progress in Nonmedical Treatment of Visceral Pain
15.2.1 Transcranial Direct Current Stimulation
15.2.2 Transcranial Magnetic Stimulation
15.2.3 Transcutaneous Electrical Nerve Stimulation
15.2.4 Neurolysis
15.2.5 Psychological Intervention
15.3 Other Progress in Treatment of Visceral Pain
15.3.1 Dietotherapy
15.3.1.1 Role of Diet Management in IBS Treatment
15.3.1.2 Introduction of Low-FODMAP Diet
15.3.1.3 Mechanisms of Low FODMAP Diet
15.3.1.4 Effectiveness of Low FODMAP Diet
Short-Term Clinical Outcome
Long-Term Clinical Outcome
15.3.1.5 Potential Risks of Low FODMAP Diet
Microbiota in the Gastrointestinal Tract
Nutritional Intake
15.3.2 Probiotic Therapy
15.4 Conclusion
References