[...]... Gastroenterology and Hepatology, and Enteric Neuromuscular Disorders and Pain Center, University of Texas Medical Branch, Galveston, Texas, U.S.A Naoki Yoshimura Departments of Urology and Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A Section I 1 INTRODUCTION AND OVERVIEW OF VISCERAL AND ABDOMINAL PAIN Distinctive Clinical and Biological Characteristics of Visceral. .. evoked by visceral stimuli Distinctive Clinical and Biological Characteristics of Visceral Pain 3 PSYCHOPHYSICAL STUDIES OF VISCERAL SENSATION To determine whether uncontrolled clinical observations are indeed representative of responses evoked by visceral pain rather than a nonspecific characterization of chronic pain, psychophysical studies have been performed using controlled visceral and nonvisceral... terms ‘ visceral pain’’ and ‘‘functional abdominal pain’’ will be used interchangeably throughout this chapter Epidemiology of Abdominal Pain The symptom of abdominal pain is common in the community, with prevalence rates between 22% and 28% (1–3) Women are more likely than men to complain of abdominal pain and bloating It is noteworthy that only one in five of people in the community with abdominal. .. NEUROBIOLOGY AND PSYCHOBIOLOGY OF CHRONIC VISCERAL PAIN Overview of Pain and Sensitization Michael S Gold Department of Biomedical Sciences, Dental School, Program in Neuroscience, and Department of Anatomy and Neurobiology, Medical School, University of Maryland, Baltimore, Maryland, U.S.A WHAT IS PAIN? The International Association for the Study of Pain (IASP) has defined pain as an unpleasant sensory and. .. the epidemiology of the main visceral and abdominal pain syndromes a clinician is likely to encounter ABDOMINAL PAIN Abdominal pain can be an indication of a specific underlying disease, but in many sufferers, establishing a diagnosis is difficult, especially if the pain is longstanding, recurrent, and without specific pathophysiological abnormality Such pain is thought to be visceral in origin, because... Bowel Syndrome and Functional Abdominal Pain Syndromes: Pathophysiology 341 Andrew W DuPont and Pankaj Jay Pasricha Introduction and Nature of the Problem 341 Is Pain Secondary to Motility Abnormalities in IBS? 342 Is Pain Secondary to Disturbances in Sensory Processing (Visceral Hypersensitivity)? 343 Visceral Hypersensitivity: Central or Peripheral? 345 Etiopathogenesis of Visceral Hypersensitivity... intermittent abdominal pain, 20% have chest pain, and 24% of women have pelvic pain Only a minority of these people seek care The population that seeks care is different from those who do not, and thus population-based studies are needed to truly understand the epidemiology of these visceral and abdominal pain syndromes These conditions are associated with diminished quality of life, and when people... innervations are the wandering inputs and outputs of the vagus nerve and an elaborate local ganglionic circuitry The result is that pelvic organs such as the urinary bladder, gynecological structures, and the lower gastrointestinal (GI) tract have a complex and doubly diffuse neuroanatomy Taken together, from a macro- to microscopic level, there is an imprecise and diffuse organization of visceral primary... activated by noxious visceral stimuli are also activated by noxious cutaneous stimuli Where visceral pains differ from superficial pain is in the encoding properties of visceral primary afferent transducers and in their distribution to and within the central nervous system The final consequence of these dissimilarities is a difference in localization and a difference in the magnitude of emotional and autonomic... hypersensitivity’’ was coined to describe discomfort and pain in the absence of obvious visceral pathology (7) The clinical feature of visceral pain that is considered its hallmark finding is its poor and unreliable localization Researchers and thinkers from Lewis (8) to Procacci et al (9) to the present (1–6) have debated concepts of ‘‘true’’ visceral pain versus ‘‘referred’’ visceral pain— the distinction between . xiii SECTION I: INTRODUCTION AND OVERVIEW OF VISCERAL AND ABDOMINAL PAIN 1. Distinctive Clinical and Biological Characteristics of Visceral Pain 1 T. J. Ness Introduction. 8 2. Epidemiology and Socioeconomic Impact of Visceral and Abdominal Pain Syndromes 11 Smita L. S. Halder and G. Richard Locke III Introduction . . . . 11 Abdominal