Chronic Abdominal and Visceral Pain: Theory and Practice PDF
Preview Chronic Abdominal and Visceral Pain: Theory and Practice
2897_C000a.indd 1 09/26/2006 1:17:36 PM 2897_C000a.indd 2 09/26/2006 1:17:37 PM Chronic Abdominal and Visceral Pain Theory and Practice edited by Pankaj Jay Pasricha University of Texas Medical Branch Galveston, Texas, U.S.A. William D. Willis University of Texas Medical Branch Galveston, Texas, U.S.A. G. F. Gebhart University of Pittsburgh Pittsburgh, Pennsylvania, U.S.A. 2897_C000a.indd 3 09/26/2006 1:17:37 PM Informa Healthcare USA, Inc. 270 Madison Avenue New York, NY 10016 © 2007 by Informa Healthcare USA, Inc. Informa Healthcare is an Informa business No claim to original U.S. Government works Printed in the United States of America on acid‑free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number‑10: 0‑8493‑2897‑7 (Hardcover) International Standard Book Number‑13: 978‑0‑8493‑2897‑8 (Hardcover) This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. 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Visit the Informa Web site at www.informa.com and the Informa Healthcare Web site at www.informahealthcare.com 2897_C000a.indd 4 09/26/2006 1:17:37 PM Preface Ifanythingailaman,sothathedoesnotperformhisfunctions,ifhehaveapaininhisbowelseven,—forthatis theseatofsympathy,—heforthwithsetsaboutreforming—theworld.–HenryDavidThoreau(1817–1862) There is almost no physician who has not encountered the problem of chronic visceral painatsomepointinhisorhercareer.Visceralandabdominalpainisamajorclinicalproblem, affectingupto25%ofthegeneralU.S.population.Itmaybepartofawell-definedsyndrome such as irritable bowel syndrome or chronic pancreatitis or be the sole or dominant clinical manifestationasinfunctionalabdominalpainanddyspepsia.Patientswithsuchpainpresent to a variety of medical specialists including gastroenterologists, cardiologists (noncardiac chest pain), gynecologists (pelvic pain syndromes) or urologists (interstitial cystitis etc.), anesthesiologists.Thelasttwodecadeshaveseenimpressiveprogressintheneurobiologyof somaticpainandthisisnowbeginningtobetranslatedintoclinicalpracticewiththeadvent of several new classes of analgesics, particularly for neuropathic syndromes. By contrast, despiteitsprevalence,chronicvisceralpainremainspoorlyunderstood,leadingtosignificant difficulty in diagnosis and management. Much of modern medicine has tended to dismiss chronic visceral pain, in part because changes in function and structure of visceral organs are more subtle than those seen in somatic structures (a deformed and swollen knee for instance). Indeed, the term ‘‘functional pain’’ is often used (pejoratively) for these patients, generally in association with a referral to a clinical psychologist. The editors of this book feel fortunate and privileged to be able to assemble leading expertsfromacrosstheworldtowritethefirstdefinitiveandcomprehensiveworkonthissub- ject and one that is truly ‘‘bench to bedside.’’ Conceptually, this book is divided into four sections. The first deals with a global overview of visceral pain, its distinctive features and socialimpact.Thesecondsection,writtenbymanyoftheauthorswhohavedefinedthepara- digms in this field, provides a detailed discussion of the neurobiological, immunological, andpsychologicalbasisofvisceralpain,asprovidedbythestudyofbothanimalmodelsand humansubjects.The nextsection dealswith thegrowingarrayof molecular targetsfor treat- ment of visceral pain as well as current conventional and alternative approaches used in the clinic. The final section consists of a detailed discussion of individual syndromes covering the gamut ofproblemsencounteredbythe practicing physician.In most instances, two lead- ing authorities in the field have provided a state-of-the-art summary of the pathophysiology and management of these conditions, often bringing unique insight as well as practical tips. The reader can approach this book in many different ways. For the novice clinician or researcher, if read as written, it will be an easily understood journey of discovery from basic anatomic and physiological principles to an understanding of the complex balance of patho- physiological factors that make up a given clinical syndrome and rational approaches to treatment of the same. For the expert, individual chapters can be perused with ease for an in-depthandup-to-datereviewofthetopic.Eitherway,weareconfidentthattheexperience will be rewarding and stimulating. Itisclearthatvisceralpainsyndromesarecomplex,possiblymoresothantheirsomatic counterparts. The editors of this book hope that we have been able to put together a compi- lation of work that will provide the beginning of a rational approach to this symptom and the recognition of the real suffering it causes. Painisrealwhenyougetotherpeopletobelieveinit.Ifnoonebelievesinitbutyou,yourpainismadnessor hysteria.–NaomiWolf(b.1962) Pankaj Jay Pasricha William D. Willis G. F. Gebhart Contents Preface . . . . iii Contributors . . . . xiii SECTION I:INTRODUCTION ANDOVERVIEW OFVISCERAL AND ABDOMINALPAIN 1. Distinctive Clinical andBiological Characteristics ofVisceral Pain 1 T.J.Ness Introduction . . . . 1 ClinicalVisceralPain . . . . 1 ClinicalSuperficialPain . . . . 2 PsychophysicalStudiesofVisceralSensation . . . . 3 NeuroanatomyofVisceralPain . . . . 4 DifferencesinSpinalPathways . . . . 5 FunctionalImagingofVisceralSensation . . . . 6 EffectsofStressonVisceralPain . . . . 6 SilentAfferentsintheViscera . . . . 7 AreAllVisceralPainstheSame? . . . . 7 References . . . . 8 2. EpidemiologyandSocioeconomic Impact ofVisceral and AbdominalPain Syndromes 11 SmitaL. S.Halder and G.Richard Locke III Introduction . . . . 11 AbdominalPain . . . . 11 SpecificVisceralandAbdominalPainSyndromes . . . . 12 Conclusions . . . . 15 References . . . . 15 SECTION II:THE NEUROBIOLOGYAND PSYCHOBIOLOGY OFCHRONICVISCERAL PAIN 3. Overview ofPainand Sensitization 17 MichaelS. Gold WhatisPain? . . . . 17 PainTerminology . . . . 18 SummaryandConclusions . . . . 27 References . . . . 27 4. NeuroanatomyofVisceralPain: PathwaysandProcesses 33 ElieD. Al-Chaer and William D. Willis PeripheralPathways . . . . 33 CentralPathways . . . . 34 RepresentationofVisceralSensationintheBrain . . . . 38 References . . . . 39 5. TheNeurobiologyofVisceralNociceptors 45 StuartM.Brierley and L.Ashley Blackshaw Introduction . . . . 45 IrritableBowelSyndrome . . . . 45 SensoryInnervationoftheGastrointestinalTract . . . . 46 Conclusions . . . . 60 References . . . . 60 vi Contents 6. Neurochemical andMolecular BasisofPeripheral Sensitization 67 Klaus Bielefeldt Introduction . . . . 67 IonChannelsasTransducers . . . . 67 SynapticTransmission . . . . 75 Nerve-ImmuneInteractionsandPeripheralSensitization . . . . 76 PeripheralSensitizationandVisceralPainSyndromes . . . . 77 References . . . . 78 7. SpinalMechanisms ofVisceral Pain andSensitization 85 Richard J.Traub Introduction . . . . 85 VisceralAfferentOrganizationContributingto VisceralPainandHyperalgesia . . . . 86 ReferredPainandHyperalgesia:Convergenceofthe SomaticandVisceralBody . . . . 88 MeasurementofExperimentalVisceralPainandHyperalgesia . . . . 91 PharmacologyofSpinalProcessingofVisceralPain . . . . 95 GonadalHormoneModulationofVisceralPain . . . . 97 ConclusionsandaHypothesis . . . . 97 References . . . . 98 8. Animal Modelsof Visceral Pain 107 David R.Robinson and G.F.Gebhart Introduction . . . . 107 TheCardiopulmonarySystem . . . . 109 TheGastrointestinalTract . . . . 111 TheGenitourinaryTract . . . . 116 ClosingNotes . . . . 121 References . . . . 121 9. Measuring PainandHyperalgesia inPersistent Pain Conditionswith a Special Emphasis onIrritable Bowel Syndrome 127 Donald D.Price, Michael E.Robinson, and G.Nicholas Verne Introduction . . . . 127 GeneralConsiderationsConcerningPainMeasurement . . . . 127 PsychophysicalCharacterizationofPathophysiologicalPain . . . . 128 TestingVisceralandCutaneousHyperalgesiain IrritableBowelSyndromePatients . . . . 132 ConclusionsandFutureImplications . . . . 137 References . . . . 138 10. Mechanisms ofVisceralSensitization inHumans 141 Abhishek Sharmaand Q. Aziz Background . . . . 141 TheModulationofPainPerception . . . . 141 VisceralHypersensitivity . . . . 141 VariabilityintheDevelopmentofSensitizedStates . . . . 149 MechanismsofVisceralSensitizationinFunctionalGastrointestinalDisorder . . . . 150 Summary . . . . 154 References . . . . 155 11. Visceral Pain:LessonsfromFunctional Brain Imaging 161 EmeranA.Mayer and BruceNaliboff Introduction . . . . 161 ReviewofPublishedStudiesonBrainResponsesto VisceralStimuli . . . . 161 ConclusionsandFutureDirections . . . . 171 References . . . . 172 Contents vii 12. The NeuralBasisofReferredVisceralPain 177 MariaAdele Giamberardino and FernandoCervero Introduction . . . . 177 ReferredPainPhenomenaintheClinicalContext . . . . 177 ReferredPainPhenomenaintheExperimentalContext . . . . 180 NeurophysiologicalBasisofReferredPain . . . . 183 Conclusion . . . . 189 References . . . . 189 13. FromSensation to Perception: The Gut–Brain Connection 193 FernandoAzpiroz GeneralOverview . . . . 193 EvaluationofVisceralSensitivityinHumans . . . . 194 ModulationofVisceralPerception . . . . 197 DysfunctionoftheSensorySystem:FunctionalGutDisorders . . . . 198 References . . . . 201 14. Stress,VisceralPain, andthe Brain–GutConnections 205 Yvette Tache´ and MulugetaMillion Introduction . . . . 205 Stress-InducedVisceralHyperalgesia . . . . 205 Stress-InducedSomaticandVisceralHypoalgesia . . . . 208 CRF/CRF ReceptorsandtheBiochemicalCodingofStress . . . . 209 1 BrainCRF/CRF-SignalingPathwaysinStress-Related 1 VisceralHyperalgesia . . . . 210 Conclusions . . . . 213 References . . . . 213 15. The Biopsychosocial Continuum inVisceral Pain inChronicAbdominaland Visceral Pain:Theory andPractice 221 DouglasA.Drossman Introduction . . . . 221 TheBiopsychosocialContinuum . . . . 222 Pathophysiology . . . . 223 ClinicalPresentationBasedonSeverityofPainand ImplicationsforTreatment . . . . 227 Conclusion . . . . 228 References . . . . 229 16. ChronicPainandAddiction 231 HowardHeitand Douglas Gourlay Introduction . . . . 231 BinaryConceptofPainandAddiction . . . . 231 PainandOpioidAddiction—AContinuumApproach . . . . 232 BasicScienceofAddiction . . . . 233 Addiction . . . . 234 PhysicalDependence . . . . 234 Tolerance . . . . 234 BasicConceptsintheUseofOpioids . . . . 236 Modified-ReleaseDeliverySystems . . . . 237 Long-actingDrugs . . . . 238 OpioidsforAnalgesiaorOpioidStabilizingEffect? . . . . 238 UniversalPrecautionsinPainMedicine . . . . 239 GroupIPrimaryCareManagement . . . . 239 GroupIIPrimaryCarewithConsultativeSupport . . . . 239 GroupIIISpecialtyReferral . . . . 240 ClassificationofPain . . . . 240 SpecificPainCondition . . . . 241 FederalRegulationsforPrescribingaScheduled ControlledSubstance . . . . 241 Conclusion . . . . 242 References . . . . 243
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