Chronic Abdominal and Visceral Pain: Theory and Practice

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ISBN: 9780849328978 | 0849328977
Cover: Hardcover
Copyright: 11/2/2006

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Standing alone as the first definitive and comprehensive book on the subject, this guide describes the most recent studies on the brain-gut connection and psychosocial issues related to patients experiencing visceral pain. Bringing together leading experts from the top-tiers of the science, this source provides 33 engaging chapters and spans basic concepts in pharmacology, neurobiology, physiology, and psychology to provide a practical approach to the treatment of chronic pain.

Preface

iii

Contributors

xiii

SECTION I: INTRODUCTION AND OVERVIEW OF VISCERAL AND ABDOMINAL PAIN

Distinctive Clinical and Biological Characteristics of Visceral Pain

(10)

T. J. Ness

Introduction

(1)

Clinical Visceral Pain

(1)

Clinical Superficial Pain

(1)

Psychophysical Studies of Visceral Sensation

(1)

Neuroanatomy of Visceral Pain

(1)

Differences in Spinal Pathways

(1)

Functional Imaging of Visceral Sensation

(1)

Effects of Stress on Visceral Pain

(1)

Silent Afferents in the Viscera

(1)

Are All Visceral Pains the Same?

(1)

References

(3)

Epidemiology and Socioeconomic Impact of Visceral and Abdominal Pain Syndromes

(6)

Smita L. S. Halder

G. Richard Locke III

Introduction

(1)

Abdominal Pain

(1)

Specific Visceral and Abdominal Pain Syndromes

(3)

Conclusions

(1)

References

(2)

SECTION II: THE NEUROBIOLOGY AND PSYCHOBIOLOGY OF CHRONIC VISCERAL PAIN

Overview of Pain and Sensitization

(16)

Michael S. Gold

What is Pain?

(1)

Pain Terminology

(9)

Summary and Conclusions

(1)

References

(6)

Neuroanatomy of Visceral Pain: Pathways and Processes

(12)

Elie D. Al-Chaer

William D. Willis

Peripheral Pathways

(1)

Central Pathways

(4)

Representation of Visceral Sensation in the Brain

(1)

References

(6)

The Neurobiology of Visceral Nociceptors

(22)

Stuart M. Brierley

L. Ashley Blackshaw

Introduction

(1)

Irritable Bowel Syndrome

(1)

Sensory Innervation of the Gastrointestinal Tract

(14)

Conclusions

(1)

References

(7)

Neurochemical and Molecular Basis of Peripheral Sensitization

(18)

Klaus Bielefeldt

Introduction

(1)

Ion Channels as Transducers

(8)

Synaptic Transmission

(1)

Nerve-Immune Interactions and Peripheral Sensitization

(1)

Peripheral Sensitization and Visceral Pain Syndromes

(1)

References

(7)

Spinal Mechanisms of Visceral Pain and Sensitization

(22)

Richard J. Traub

Introduction

(1)

Visceral Afferent Organization Contributing to Visceral Pain and Hyperalgesia

(2)

Referred Pain and Hyperalgesia: Convergence of the Somatic and Visceral Body

(3)

Measurement of Experimental Visceral Pain and Hyperalgesia

(4)

Pharmacology of Spinal Processing of Visceral Pain

(2)

Gonadal Hormone Modulation of Visceral Pain

(1)

Conclusions and a Hypothesis

(1)

References

(9)

Animal Models of Visceral Pain

107

(20)

David R. Robinson

G. F. Gebhart

Introduction

107

(2)

The Cardiopulmonary System

109

(2)

The Gastrointestinal Tract

111

(5)

The Genitourinary Tract

116

(5)

Closing Notes

121

(1)

References

121

(6)

Measuring Pain and Hyperalgesia in Persistent Pain Conditions with a Special Emphasis on Irritable Bowel Syndrome

127

(14)

Donald D. Price

Michael E. Robinson

G. Nicholas Verne

Introduction

127

(1)

General Considerations Concerning Pain Measurement

127

(1)

Psychophysical Characterization of Pathophysiological Pain

128

(4)

Testing Visceral and Cutaneous Hyperalgesia in Irritable Bowel Syndrome Patients

132

(5)

Conclusions and Future Implications

137

(1)

References

138

(3)

Mechanisms of Visceral Sensitization in Humans

141

(20)

Abhishek Sharma

Q. Aziz

Background

141

(1)

The Modulation of Pain Perception

141

(1)

Visceral Hypersensitivity

141

(8)

Variability in the Development of Sensitized States

149

(1)

Mechanisms of Visceral Sensitization in Functional Gastrointestinal Disorder

150

(4)

Summary

154

(1)

References

155

(6)

Visceral Pain: Lessons from Functional Brain Imaging

161

(16)

Emeran A. Mayer

Bruce Naliboff

Introduction

161

(1)

Review of Published Studies on Brain Responses to Visceral Stimuli

161

(10)

Conclusions and Future Directions

171

(1)

References

172

(5)

The Neural Basis of Referred Visceral Pain

177

(16)

Maria Adele Giamberardino

Fernando Cervero

Introduction

177

(1)

Referred Pain Phenomena in the Clinical Context

177

(3)

Referred Pain Phenomena in the Experimental Context

180

(3)

Neurophysiological Basis of Referred Pain

183

(6)

Conclusion

189

(1)

References

189

(4)

From Sensation to Perception: The Gut-Brain Connection

193

(12)

Fernando Azpiroz

General Overview

193

(1)

Evaluation of Visceral Sensitivity in Humans

194

(3)

Modulation of Visceral Perception

197

(1)

Dysfunction of the Sensory System: Functional Gut Disorders

198

(3)

References

201

(4)

Stress, Visceral Pain, and the Brain-Gut Connections

205

(16)

Yvette Tache

Mulugeta Million

Introduction

205

(1)

Stress-Induced Visceral Hyperalgesia

205

(3)

Stress-Induced Somatic and Visceral Hypoalgesia

208

(1)

CRF/CRF1 Receptors and the Biochemical Coding of Stress

209

(1)

Brain CRF/CRF1-Signaling Pathways in Stress-Related Visceral Hyperalgesia

210

(3)

Conclusions

213

(1)

References

213

(8)

The Biopsychosocial Continuum in Visceral Pain in Chronic Abdominal and Visceral Pain: Theory and Practice

221

(10)

Douglas A. Drossman

Introduction

221

(1)

The Biopsychosocial Continuum

222

(1)

Pathophysiology

223

(4)

Clinical Presentation Based on Severity of Pain and Implications for Treatment

227

(1)

Conclusion

228

(1)

References

229

(2)

Chronic Pain and Addiction

231

(14)

Howard Heit

Douglas Gourlay

Introduction

231

(1)

Binary Concept of Pain and Addiction

231

(1)

Pain and Opioid Addiction---A Continuum Approach

232

(1)

Basic Science of Addiction

233

(1)

Addiction

234

(1)

Physical Dependence

234

(1)

Tolerance

234

(2)

Basic Concepts in the Use of Opioids

236

(1)

Modified-Release Delivery Systems

237

(1)

Long-acting Drugs

238

(1)

Opioids for Analgesia or Opioid Stabilizing Effect?

238

(1)

Universal Precautions in Pain Medicine

239

(1)

Group I Primary Care Management

239

(1)

Group II Primary Care with Consultative Support

239

(1)

Group III Specialty Referral

240

(1)

Classification of Pain

240

(1)

Specific Pain Condition

241

(1)

Federal Regulations for Prescribing a Scheduled Controlled Substance

241

(1)

Conclusion

242

(1)

References

243

(2)

SECTION III: THERAPY FOR VISCERAL PAIN: SCIENTIFIC BASIS AND PRACTICE ASPECTS

Treating Visceral Pain Via Molecular Targets on Afferent Neurons: Current and Future

245

(26)

Peter Holzer

Visceral Pain Therapy: Current and Future

245

(1)

Sensory Neurons and GI Hypersensitivity

245

(1)

Criteria for the Design of Efficacious Sensory Neuron-Targeting Drugs

246

(1)

Three Classes of Sensory Neuron-Targeting Drugs

247

(1)

Sensory Neuron-Specific Receptors and Sensors

247

(6)

Ion Channels Regulating Sensory Nerve Excitability, Conduction, and Transmission

253

(1)

Receptors Relevant to Afferent Neuron Transmission

254

(4)

Conclusions

258

(1)

References

259

(12)

Management of the Patient with Chronic Abdominal Pain and Clinical Pharmacology of Nonopioid Drugs

271

(16)

Michael Camilleri

Introduction

271

(1)

Establishing a Roadmap

271

(11)

Conclusion

282

(1)

References

282

(5)

Pharmacology and Practice of Opioid Drugs for Visceral Pain

287

(14)

Jane C. Ballantyne

Introduction

287

(1)

Pharmacology

287

(4)

Acute Visceral Pain

291

(1)

Long-Term Opioid Treatment and its Liabilities

291

(3)

Psychosomatic Gastrointestinal and Genitourinary Disease

294

(1)

Specific Conditions

295

(1)

Conclusion

296

(1)

References

297

(4)

Clinical Approach to Visceral Cancer Pain

301

(10)

Sebastiano Mercadante

Mechanisms

301

(1)

Clinical Implications in Cancer Pain

301

(1)

Treatment

302

(4)

Techniques

306

(2)

Conclusion

308

(1)

References

308

(3)

Neuromodulation Techniques for Visceral Pain from Benign Disorders

311

(12)

Charles D. Brooker

Michael J. Cousins

Introduction

311

(1)

Intrathecal Drug Therapy

312

(3)

Electrical Stimulation Techniques

315

(3)

Neurolytic Techniques

318

(1)

References

319

(4)

Psychological Interventions for Patients with Chronic Abdominal and Pelvic Pain

323

(8)

Luis F. Buenaver

Robert Edwards

Jennifer A. Haythornthwaite

Introduction

323

(1)

Biofeedback

324

(1)

Hypnosis

324

(1)

Cognitive Behavior Therapy

325

(1)

Multidisciplinary Treatment

326

(1)

Future Directions

326

(1)

References

327

(4)

Complementary and Integrative Medicine Approaches to Visceral Pain

331

(10)

Victor S. Sierpina

Indumathi Kuncharapu

Introduction

331

(1)

Case Study

332

(1)

Biological Therapies

333

(2)

Mind-Body Therapies

335

(1)

Manual Therapies

335

(1)

Alternative Systems of Care

336

(1)

Bioenergetic Therapies

337

(1)

Summary

337

(1)

References

338

(3)

SECTION IV: CLINICAL SYNDROMES: PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT

Irritable Bowel Syndrome and Functional Abdominal Pain Syndromes: Pathophysiology

341

(32)

Andrew W. DuPont

Pankaj Jay Pasricha

Introduction and Nature of the Problem

341

(1)

Is Pain Secondary to Motility Abnormalities in IBS?

342

(1)

Is Pain Secondary to Disturbances in Sensory Processing (Visceral Hypersensitivity)?

343

(2)

Visceral Hypersensitivity: Central or Peripheral?

345

(5)

Etiopathogenesis of Visceral Hypersensitivity

350

(3)

Conclusions

353

(1)

References

353

(4)

Irritable Bowel Syndrome and Functional Abdominal Pain Syndromes: Clinical Features and Management

357

(1)

Lin Chang

Lucinda Harris

Introduction

357

(1)

Irritable Bowel Syndrome

358

(9)

Functional Abdominal Pain Syndrome

367

(1)

Conclusion

367

(1)

References

368

(5)

Noncardiac Chest Pain: Pathophysiology

373

(26)

Premjit S. Chahal

Satish S. C. Rao

Introduction

373

(5)

Conclusion

378

(1)

References

378

(3)

Noncardiac Chest Pain: Clinical Features and Management

381

(1)

Ronnie Fass

Ram Dickman

Introduction

381

(1)

History and Clinical Presentation

381

(1)

Epidemiology

382

(1)

Diagnosis

383

(6)

Treatment

389

(5)

Summary

394

(1)

References

395

(4)

Pathophysiology of Functional Dyspepsia

399

(16)

Jan Tack

Definitions

399

(1)

Dyspepsia Symptom Pattern

399

(1)

Subgroups of Functional Dyspepsia Patients

399

(1)

Putative Pathophysiological Mechanisms

400

(1)

Pathogenesis of Functional Dyspepsia

401

(1)

References

402

(2)

Dyspepsia: Clinical Features and Management

404

(1)

Nimish Vakil

Definitions

404

(1)

Prevalence

405

(1)

Differential Diagnosis

405

(1)

Clinical Diagnosis

406

(1)

Alarm Features

406

(1)

Management Strategies

406

(5)

References

411

(4)

Pathophysiology and Management of Pain in Chronic Pancreatitis

415

(12)

John H. Winston

Pankaj Jay Pasricha

Background and Nature of The Problem

415

(1)

Pathogenesis of Pain in Chronic Pancreatitis

415

(8)

References

423

(4)

Abdominal Wall Pain

427

(10)

David S. Greenbaum

Economic Costs

427

(1)

Prevalence

428

(1)

Nonrecognition of CAWP

428

(1)

Etiologies

428

(2)

Clinical History

430

(1)

Physical Examination

430

(1)

Reliability of Diagnosis

431

(1)

Management

432

(1)

Conclusions

433

(1)

References

434

(3)

Unexplained Visceral-Pain in Children: Pathophysiology, Clinical Features, and Management

437

(16)

Robert J. Shulman

Danita Czyzewski

Margaret Heitkemper

Introduction

437

(1)

RAP - Functional Abdominal Pain and Irritable Bowel Syndrome

438

(9)

Functional Dyspepsia

447

(1)

Summary

448

(1)

References

448

(5)

Functional Biliary Type Pain Syndromes

453

(10)

Arnold Wald

Introduction

453

(1)

Definitions

453

(1)

Epidemiology

453

(1)

Gallbladder and Biliary Anatomy and Physiology

454

(1)

Functional (Acalculous) Biliary Type Pain

454

(4)

Postcholecystectomy Functional Biliary Type Pain

458

(2)

Conclusions

460

(1)

References

460

(3)

SECTION V: PELVIC PAIN SYNDROMES

Pelvic Pain Syndromes: Pathophysiology

463

(16)

Charles H. Hubscher

Harpreet K. Chadha

Ezidin G. Kaddumi

Introduction

463

(1)

Females

463

(9)

References

472

(7)

Pelvic Pain Syndromes: Clinical Features and Management

479

(16)

Jane Moore

Stephen Kennedy

Introduction

479

(1)

Definitions and Epidemiology

479

(7)

Treatment

486

(3)

Vulval Pain

489

(1)

Conclusion

490

(1)

References

490

(5)

Interstitial Cystitis and Related Painful Bladder Syndromes: Pathophysiology

495

(26)

Naoki Yoshimura

Lori A. Birder

Introduction

495

(1)

Disease Process

495

(17)

Conclusion

512

(1)

References

512

(9)

Index

521

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Chronic Abdominal and Visceral Pain: Theory and Practice

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