Visceral pain

Pain is one of the most common symptoms that patient presents with. Visceral organs were thought to be insensitive to pain in the past, but we now know this is not true. It is more common than somatic pain and originates from the internal organs in the thorax, abdomen or pelvis. These organs are innervated by the parasympathetic (vagus and sacral parasympathetic fibres) and sympathetic (thoracolumbar sympathetic chain: T1-L2) nervous systems. The afferent and efferent fibres to the organs accompany the sympathetic nervous system. The sensory system to the gut is specialized and divided into an enteric and extrinsic nervous system. The physiology of visceral pain is poorly understood compared to somatic pain, but it is well established that peripheral and central sensitization along with dysregulation of the descending pathways plays a significant role. Pain originating from visceral organs is usually diffuse, dull aching, poorly localized and can be associated with phenomenon such as referred somatic pain, referred hyperalgesia, visceral hyperalgesia and viscero-visceral hyperalgesia. Treatment of visceral pain involves identifying and treating the cause, if identified, and the management of pain. Patient education and information plays an important part in management along with pharmacological and non-pharmacological treatments.