Chronic visceral pain from vascular mechanisms

Definition

Chronic visceral pain from vascular mechanisms is chronic visceral pain due to alterations of arterial and/or venous blood vessels to/from viscera of the head/neck region, thoracic, abdominal, and pelvic cavities, or pain conditions of the vascular system producing pain in other locations (e.g., limbs) [1-5]. Such pain can be the result of a reduction of arterial blood supply to viscera due to a diseased artery or systemic hypercoagulability, vascular functional (vasospasm) alterations or venous thrombosis. Demonstrative examples: for head/neck region, vasculitis (SLE, Polyarteritis nodosa); for thoracic region, recurrent and chronic ischemic heart disease; for abdominal region, chronic vascular disorders of intestine e.g. mesenteric angina; vasculitis such as that associated with autoimmune connective tissue diseases, e.g., Polyarteritis nodosa; for pelvic region, subacute ischemic colitis, varicosities of pelvic veins (pelvic congestion syndrome). 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) [2]. In these areas, secondary hyperalgesia (increased sensitivity to painful stimuli in areas other than the primary site of the nociceptive input) often occurs [3]. 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 relevant alterations of arterial and/or venous blood vessels from/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 vascular disease. D. The pain is not better accounted for by another diagnosis of chronic pain.

Inclusions

• Chronic visceral pain from vascular mechanisms in the head or neck region
• Chronic visceral pain from vascular mechanisms in the thoracic region
• Chronic visceral pain from vascular mechanisms in the abdominal region
• Chronic visceral pain from vascular mechanisms in the pelvic region

Index Terms