Introduction

Persistent visceral pain is a common clinical experience, but only recently have scientific studies defined its mechanisms. It is poorly understood and much of our knowledge of it is an extrapolation from acute pain studies. Pain arising from the internal organs of the body is uniquely different from pain that arises from the surface of the body in relation to the neuroanatomical substrates involved, in relation to the responses evoked by visceral stimuli, and in relation to the modifying effects of both internal and external factors. Most painful disorders associated with the viscera represent conditions of hypersensitivity made manifest by these same internal and external factors. There are underlying similarities that have been observed between multiple visceral sensory systems such that an understanding of one particular system may improve understanding of other systems. This chapter attempts to summarize what is known about persistent visceral pain by placing an emphasis on the mechanisms of visceral hypersensitivity. These mechanisms will be contrasted and compared with what is known about the more extensively studied superficial pains. This summary builds on previous reviews by this author of similar topics and general statements are referred to those reviews. ^ 2 3 4

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