Somatosensory changes in the referred pain area in patients with acute cholecystitis before and after treatment with laparoscopic or open cholecystectomy.
BACKGROUND
Visceral pain can lead to hypersensitivity in the referred pain area. In patients with chronic visceral pain this somatic hypersensitivity can persist for years. As 25%-40% of patients continue to have symptoms after cholecystectomy, whereof no explanation for pain can be offered in up to 30%, it could be hypothesized that altered sensory characteristics induced by acute cholecystitis could persist in some patients and thus be responsible for postcholecystectomy pain. The aim of this study was to investigate the somatosensory sensitivity in the referred pain area in patients with acute cholecystitis before and after cholecystectomy.


METHODS
Patients with acute cholecystitis were studied before (n = 30) and after (n = 18) treatment. Sensitivity to pinprick, heat, cold, pressure and single and repeated electrical stimulation was studied in the referred pain area and in the control area on the contralateral side of the abdomen.


RESULTS
Significant hypersensitivity in the referred pain area was detected in patients with acute cholecystitis. The somatic sensitivity was normalized after cholecystectomy.


CONCLUSIONS
Acute cholecystitis leads to hypersensitivity in the referred pain area. Persistent hypersensitivity, as earlier reported after chronic visceral pain, was not seen aftiser cholecystectomy, indicating that this mechanism may not play a major role in patients with postcholecystectomy pain syndrome. The possible role in patients operated on for chronic gallstone pain has still to be investigated.
Stawowy
M
M
Department of Surgical Gastroenterology L, Aarhus University Hospital, Denmark.
Bluhme
C
C
Arendt-Nielsen
L
L
Drewes
A M
AM
Funch-Jensen
P
P
D015746:Abdominal Pain / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D010808:Physical Examination; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D012720:Severity of Illness Index; D020886:Somatosensory Disorders / Q000175:diagnosis*; D018709:Statistics, Nonparametric