Chronic visceral pain from mechanical factors

Definition

Chronic visceral pain from mechanical factors is chronic pain deriving from a) the obstruction of hollow viscera as a consequence of internal migrating obstacles (e.g., stones) or stenosis, with dilation above the obstacle/stenosis or b) from the traction of ligaments and vessels of internal organs or the external compression of internal organs. Demonstrative examples for a): for head/neck region, stenosis of the pharynx, the larynx; for thoracic region, stenosis of the oesophagus, trachea, bronchi; for abdominal region, obstruction of the biliary tract, e.g., with stone/sclerosing cholangitis; obstruction of the renal tract, e.g., with stone; luminal obstruction of the GI tract; chronic intestinal pseudoobstruction; for pelvic region, recurrent urinary colics for lithiasis of lower urinary tract; ureteric kinking; stenosis of anus and rectum. Demonstrative examples for b): for the head/neck region, traction of ligaments and vessels or compression of the pharynx, larynx; for the thoracic region, the traction of ligaments and vessels or the compression of the oesophagus, trachea, bronchi; for the abdominal region, the traction of ligaments and vessels or the compression of the biliary tract and GI tract; the traction of ligaments and vessels or the compression of the urinary tract; for the pelvic region, the traction of ligaments and vessels or the compression of the lower urinary tract, the traction of the ovarian ligament, the compression of the male or the female reproductive organs. The pain is perceived in the somatic tissues of the body wall (skin, subcutis, muscle) in areas that receive the same sensory innervation as the internal organ at the origin of the symptom (referred visceral pain). In these areas, secondary hyperalgesia (increased sensitivity to painful stimuli in areas other than the primary site of the nociceptive input) often occurs. Diagnostic Criteria: Conditions A to D are fulfilled: A. Chronic pain (persistent or recurrent for longer than 3 months) is present and characterized by both of the following: A.1 The distinct anatomical location is compatible with typical referral pain patterns from specific internal organs. A.2 The history is suggestive of mechanical factors (obstruction/distension of hollow internal organs or traction/compression of ligaments and vessels to internal organs) B. At least one confirmatory test demonstrates an anatomical location compatible with a specific referred pain pattern. C. At least one confirmatory test demonstrates the relevant mechanical factor (distension/contraction or traction/compression mechanism). D. The pain is not better accounted for by another diagnosis of chronic pain.

Inclusions

• Chronic visceral pain from mechanical factors in the head or neck region
• Chronic visceral pain from mechanical factors in the thoracic region
• Chronic visceral pain from mechanical factors in the abdominal region
• Chronic visceral pain from mechanical factors in the pelvic region

Index Terms