Treatment

Visceral pain is often temporal in nature and does not require procedural intervention for pain. For more chronic visceral pain conditions produced from cancer, pain relieving choices can be employed. As mentioned previously the sympathetic nervous system is involved in the transmission of visceral pain. When sympathetic outflow to the viscera is blocked it is possible to experience pain relief. Taking these experiences into account sympathetic axis blockade has been used for ablation of visceral pain (Gofeld and Faclier 2006). It was not until the late 1940s when local anesthetic blockade of the splanchnic and celiac plexus was first advocated to relieve non-surgical abdominal pain. With the use of improved radiographic tools and an understanding of the risks and complications of the block, these techniques can be powerful tools in controlling visceral pain.

Non-opioids are often insufficient in relieving pain to an acceptable level in patients suffering from severe pain originating from the gastrointestinal tract. Opioids have been studied in the use in visceral pain models, and differences in opioid analgesia have been observed. One study compared morphine to oxycodone showed oxycodone has a superior effect on visceral pain than morphine indicating oxycodone may interact with different visceral opi-oid receptors compared to morphine. Ketamine, a N-methyl-D-aspartate (NMDA) receptor antagonist, is known to also bind to opioid receptors (Willert et al. 2004). Ketamine has the added benefit of counteracting spinal sensitization or windup phenomena experienced with chronic pain. In visceral pain models ketamine has been found to decrease the pain during visceral distention and prevent development of hyperalgesia and reverses induced hyperalgesia.

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