Visceral pain is pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs). Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation, but relatively insensitive to other stimuli that normally evoke pain such as cutting or burning. Visceral pain is diffuse, difficult to localize and often referred to a distant, usually superficial, structure. It may be accompanied by symptoms such as nausea, vomiting, changes in vital signs as well as emotional manifestations. The pain may be described as sickening, deep, squeezing, and dull. Distinct structural lesions or biochemical abnormalities explain this type of pain in only a proportion of patients. These diseases are grouped under gastrointestinal neuromuscular diseases (GINMD). Others can experience occasional visceral pains, often very intense in nature, without any evidence of structural, biochemical or histolopathologic reason for such symptoms. These diseases are grouped under functional gastrointestinal disorders (FGID) and the pathophysiology and treatment can vary greatly from GINMD. The two major single entities among functional disorders of the gut are functional dyspepsia and irritable bowel syndrome.
Visceral hypersensitivity is hypersensitive visceral pain perception, which is commonly experienced by individuals with functional gastrointestinal disorders.
Epidemiology
In the past, viscera were considered insensitive to pain but now it is clear that pain from internal organs is widespread and that its social burden may surpass that of pain from superficial (somatic) sources. Myocardial ischemia, the most frequent cause of cardiac pain, is the most common cause of death in the United States. Urinary colic produced from ureteral stones has been categorized as one of the most intense forms of pain that a human being can experience. The prevalence of such stones has continuously increased, reaching values of over 20% in developed countries. Surveys have shown prevalence rates among adults of 25% for intermittent abdominal pain and 20% for chest pain; 24% of women experience pelvic pain at any point in time. For over two-thirds of those affected, pain is accepted as part of daily life and symptoms are self-managed; a small proportion defer to specialists for help. Visceral pain conditions are associated with diminished quality of life, and exert a huge cost burden through medical expenses and lost productivity in the workplace.
Clinical presentation
Visceral pain should be suspected when vague midline sensations of malaise are reported by a patient. True visceral pain is characterized as a vague, diffuse, and poorly defined sensation. Regardless of specific organ of origin, the pain is usually perceived in the midline spanning anywhere from the lower abdomen up to the chest. In the early phases the pain is perceived in the same general area and it has a temporal evolution, making the onset sensation insidious and difficult to identify.
The pain is typically associated with involvement of the autonomic nervous system. Some of these symptoms include pallor, sweating, nausea, vomit, changes in vital signs including blood pressure, heart rate and/or temperature. Strong emotional reactions are also common presenting signs and may include anxiety, anguish and a sense of impending doom. Visceral pathology may also manifest only through emotional reactions and discomfort where no pain is reported. The intensity of visceral pain felt might have no relationship to the extent of internal injury.
Visceral pain changes in nature as it progresses. Pain from a specific organ can be experienced, or "referred" to different sites of the body. There is no pathology or no cause for pain at these referred somatic sites however the pain will be experienced at this location, often with significant intensity. Referred pain is sharper, better localized, and less likely to be accompanied by autonomic or emotional signs.