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Visceral Pain
Sarah Ashley Low, MD
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KEY FACTS

  • Somatic vs. Visceral Pain

    TERMINOLOGY

    • Abbreviations

      • Autonomic nervous system (ANS)
    • Definitions

      • Somatic pain: Noxious sensation from skin, muscles, bones, and soft tissues; sharp and burning in nature; easy to localize and transduced along spinal nerves
      • Visceral pain: Noxious sensation from visceral organs that can be perceived at site other than location of insult characterized as aching, pressure, or deep squeezing
      • Dermatome: Area of skin that is innervated by receptive field of single spinal nerve
      • Osteotome: Bone pain from vertebral segments that is referred to surface of body
      • Myotome: Areas of muscle innervated by single spinal segmental nerves
      • Sympathotome: Sympathetic innervation of organs that ascends centrally to ANS via anterolateral pathway
      • Sclerotome: Region of bone and periosteum that is innervated by single spinal segment
      • Referred pain: Pain perceived at site other than location of insult or tissue damage
      • Visceral-somatic pain: Nerve fibers that transduce sensory information from viscera and their capsules
      • Viscerovisceral pain: Pain from visceral capsules and lining of visceral cavities
      • Enhanced recovery after surgery (ERAS): Protocol that implement multimodal perioperative care strategies to achieve early recovery after surgery by maintaining preoperative organ function and reducing stress response from surgery
      • Enhanced recovery after interventional procedure (ERAP): Protocol that implement multimodal periprocedural care strategies to achieve early recovery after painful procedures by further reducing stress response from procedure

    CLINICAL IMPLICATIONS

    • Somatic vs. Visceral Pain

      • Autonomic Nervous System Layout

        • Pain Has Both Somatic and Sympathetic Components

          • Pain and Injurious Milieu

            • Procedural Tissue Damage

              • Inflammation and Vicious Feed Forward Cycle

                Selected References

                1. Simpson JC et al: Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg. 32(2):121-8, 2019
                2. Haines DE et al: Viscerosensory pathways. In Fundamental Neuroscience for Basic and Clinical Applications. Philadelphia, PA: Elsevier. 278-85, 2018
                3. Baldock R et al: The axial musculoskeletal system. In Kaufman's Atlas of Mouse Development Supplement. Amsterdam: Academic Press. 165-75,  2015
                4. Sikandar S et al: Visceral pain: the ins and outs, the ups and downs. Curr Opin Support Palliat Care. 6(1):17-26, 2012
                5. Ji SP et al: [Study of treatment of hyaline membrane disease with pulmonary surfactant replacement in premature infant.] Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 19(4):248, 2007
                6. Cervero F et al: Visceral pain. Lancet. 353(9170):2145-8, 1999
                7. Woolf CJ et al: Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 77(2):362-79, 1993
                Related Anatomy
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                References
                Tables

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                KEY FACTS

                • Somatic vs. Visceral Pain

                  TERMINOLOGY

                  • Abbreviations

                    • Autonomic nervous system (ANS)
                  • Definitions

                    • Somatic pain: Noxious sensation from skin, muscles, bones, and soft tissues; sharp and burning in nature; easy to localize and transduced along spinal nerves
                    • Visceral pain: Noxious sensation from visceral organs that can be perceived at site other than location of insult characterized as aching, pressure, or deep squeezing
                    • Dermatome: Area of skin that is innervated by receptive field of single spinal nerve
                    • Osteotome: Bone pain from vertebral segments that is referred to surface of body
                    • Myotome: Areas of muscle innervated by single spinal segmental nerves
                    • Sympathotome: Sympathetic innervation of organs that ascends centrally to ANS via anterolateral pathway
                    • Sclerotome: Region of bone and periosteum that is innervated by single spinal segment
                    • Referred pain: Pain perceived at site other than location of insult or tissue damage
                    • Visceral-somatic pain: Nerve fibers that transduce sensory information from viscera and their capsules
                    • Viscerovisceral pain: Pain from visceral capsules and lining of visceral cavities
                    • Enhanced recovery after surgery (ERAS): Protocol that implement multimodal perioperative care strategies to achieve early recovery after surgery by maintaining preoperative organ function and reducing stress response from surgery
                    • Enhanced recovery after interventional procedure (ERAP): Protocol that implement multimodal periprocedural care strategies to achieve early recovery after painful procedures by further reducing stress response from procedure

                  CLINICAL IMPLICATIONS

                  • Somatic vs. Visceral Pain

                    • Autonomic Nervous System Layout

                      • Pain Has Both Somatic and Sympathetic Components

                        • Pain and Injurious Milieu

                          • Procedural Tissue Damage

                            • Inflammation and Vicious Feed Forward Cycle

                              Selected References

                              1. Simpson JC et al: Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg. 32(2):121-8, 2019
                              2. Haines DE et al: Viscerosensory pathways. In Fundamental Neuroscience for Basic and Clinical Applications. Philadelphia, PA: Elsevier. 278-85, 2018
                              3. Baldock R et al: The axial musculoskeletal system. In Kaufman's Atlas of Mouse Development Supplement. Amsterdam: Academic Press. 165-75,  2015
                              4. Sikandar S et al: Visceral pain: the ins and outs, the ups and downs. Curr Opin Support Palliat Care. 6(1):17-26, 2012
                              5. Ji SP et al: [Study of treatment of hyaline membrane disease with pulmonary surfactant replacement in premature infant.] Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 19(4):248, 2007
                              6. Cervero F et al: Visceral pain. Lancet. 353(9170):2145-8, 1999
                              7. Woolf CJ et al: Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 77(2):362-79, 1993