Viscero-visceral hyperalgesia: characterization in different clinical models.
Co-existing algogenic conditions in two internal organs in the same patient may mutually enhance pain symptoms (viscero-visceral hyperalgesia). The present study assessed this phenomenon in different models of visceral interaction. In a prospective evaluation, patients with: (a) coronary artery disease (CAD)+gallstone (Gs) (common sensory projection: T5); (b) irritable bowel syndrome (IBS)+dysmenorrhea (Dys) (T10-L1); (c) dysmenorrhea/endometriosis+urinary calculosis (Cal)(T10-L1); and (d) gallstone+left urinary calculosis (Gs+LCal) (unknown common projection) were compared with patients with CAD, Gs, IBS, Dys or Cal only, for spontaneous symptoms (number/intensity of pain episodes) over comparable time periods and for referred symptoms (muscle hyperalgesia; pressure/electrical pain thresholds) from each visceral location. In patients' subgroups, symptoms were also re-assessed after treatment of each condition or after no treatment. (a) CAD+Gs presented more numerous/intense angina/biliary episodes and more referred muscle chest/abdominal hyperalgesia than CAD or Gs; cardiac revascularization or cholecystectomy also reduced biliary or cardiac symptoms, respectively (0.001<p<0.05). (b) IBS+Dys had more intestinal/menstrual pain and abdomino/pelvic muscle hyperalgesia than IBS or Dys; hormonal dysmenorrhea treatment also reduced IBS symptoms; IBS dietary treatment also improved dysmenorrhea (0.001<p<0.05) while no treatment of either conditions resulted in no improvement in time of symptoms from both. (c) Cal+Dys had more urinary/menstrual pain and referred lumbar/abdominal hyperalgesia than Cal or Dys; hormonal dysmenorrhea treatment/laser treatment for endometriosis also improved urinary symptoms; lithotripsy for urinary stone also reduced menstrual symptoms (0.001<p<0.05). (d) In Gs+LCal, cholecystectomy or urinary lithotripsy did not improve urinary or biliary symptoms, respectively. Mechanisms of viscero-visceral hyperalgesia between organs with documented partially common sensory projection probably involve sensitization of viscero-viscero-somatic convergent neurons.
Giamberardino
Maria Adele
MA
Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti, Italy Institute of Surgical Pathology, G. D'Annunzio University of Chieti, Italy.
Costantini
Raffaele
R
Affaitati
Giannapia
G
Fabrizio
Alessandra
A
Lapenna
Domenico
D
Tafuri
Emmanuele
E
Mezzetti
Andrea
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods; D003109:Colonic Diseases, Functional / Q000150:complications; D004412:Dysmenorrhea / Q000150:complications / Q000628:therapy; D004715:Endometriosis / Q000150:complications; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000601:surgery; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000628:therapy; D006331:Heart Diseases / Q000150:complications* / Q000628:therapy; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology* / Q000628:therapy*; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D014545:Urinary Calculi / Q000150:complications / Q000628:therapy; D014781:Viscera / Q000503:physiopathology*; D055815:Young Adult