Visceral Pain

  • Leonardo Kapural
  • Jeremy Naber


Abdominal pain is present in over two million people across the USA and is the most common presenting symptom in gastrointestinal clinics. Before being referred to chronic pain specialist, patients frequently undergo numerous imaging studies and surgical procedures. Despite extensive diagnostics, some of the causes of chronic abdominal pain remain unknown. Chronic abdominal pain is characterized by referral to cutaneous regions, difficulty in localizing the pain, and augmented autonomic and/or motor reflexes and can be accompanied by a significant hyperalgesia with referral to cutaneous and deep tissues. A comprehensive multidisciplinary approach is critical to optimizing outcomes. Interventional procedures used to treat abdominal pain include sympathetic blocks and spinal cord stimulation.


Chronic abdominal pain Abdominal wall pain Visceral pain Inflammatory bowel disease Ulcerative colitis Crohn’s Pancreatitis Irritable bowel syndrome ACNES 


  1. 1.
    Anaparthy R, Pasricha PJ. Pain and chronic pancreatitis: is it the plumbing or the wiring? Curr Gastroenterol Rep. 2008;10:101–6.CrossRefGoogle Scholar
  2. 2.
    Azpiroz F, Bouin M, Camilleri M, et al. Mechanisms of hypersensitivity in IBS and functional disorders. Neurogastroenterol Motil. 2007;19(1 Suppl):62–88.CrossRefGoogle Scholar
  3. 3.
    Jones RC 3rd, Xu L, Gebhart GF. The mechanosensitivity of mouse colon afferent fibers and their sensitization by inflammatory mediators require transient receptor potential vanilloid 1 and acid-sensing ion channel 3. J Neurosci. 2005;25(47):10981–9.CrossRefGoogle Scholar
  4. 4.
    DiMagno MJ, DiMagno EP. Chronic pancreatitis. Curr Opin Gastroenterol. 2012;28:523–31.CrossRefGoogle Scholar
  5. 5.
    Pasricha PJ. Unraveling the mystery of pain in chronic pancreatitis. Nat Rev Gastroenterol Hepatol. 2012;9:140–51.CrossRefGoogle Scholar
  6. 6.
    Wallander MA, Johansson S, Ruigomez A, Garcia Rodriguez LA. Unspecified abdominal pain in primary care: The role of gastrointestinal morbidity. Int J Clin Pract. 2007;61(10):1663–70.CrossRefGoogle Scholar
  7. 7.
    Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhea in the united states: Prevalence and impact. Dig Dis Sci. 2000;45(6):1166–71.CrossRefGoogle Scholar
  8. 8.
    Heading RC. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol Suppl. 1999;231:3–8.PubMedGoogle Scholar
  9. 9.
    Calkins BM, Mendeloff AI. Epidemiology of inflammatory bowel disease. Epidemiol Rev. 1986;8:60–91.CrossRefGoogle Scholar
  10. 10.
    Calkins BM, Lilienfeld AM, Garland CF, Mendeloff AI. Trends in incidence rates of ulcerative colitis and Crohn’s disease. Dig Dis Sci. 1984;29(10):913–20.CrossRefGoogle Scholar
  11. 11.
    Puylaert M, Kapural L, van Zundert J, Peek D, Lataster A, Mekhail N, van Kleef M, Keulemans Y. Pain in chronic pancreatitis (Chapter 26). In: van Zundert J, Patjin J, Hartrick C, Lataster A, Huygen F, Mekhail N, van Kleff M, editors. Evidence-based interventional pain practice: according to clinical diagnoses. Oxford: Wiley Blackwell; 2012. p. 202–12.Google Scholar
  12. 12.
    Tolba R. Rizk. The epidemiology of chronic abdominal pain. In: Kapural L, editor. Chronic abdominal pain, an evidence-based comprehensive guide to clinical management. New York: Springer; 2015. p. 195–201.Google Scholar
  13. 13.
    Chrona E, Kostopanagiotou G, Damigos D, Batistaki C. Anterior cutaneous nerve entrapment syndrome: management challenges, vol. 97; 2002. p. 824–30.Google Scholar
  14. 14.
    Lindsetmo R, Stulberg J. Chronic abdominal wall pain—a diagnostic challenge for the surgeon. Am J Surg. 2009;198:129–34.CrossRefGoogle Scholar
  15. 15.
    Carnett JB. Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gynecol Obstet. 1926;42:625–32.Google Scholar
  16. 16.
    Sharpstone D, Colin-Jones DG. Chronic, non-visceral abdominal pain. Gut. 1994;35:833–6.CrossRefGoogle Scholar
  17. 17.
    Narouze S. Chronic abdominal wall pain: diagnosis and interventional treatment. In: Kapural L, editor. Chronic abdominal pain: an evidence-based, comprehensive guide to clinical management. New York: Springer; 2015. p. 189–95.Google Scholar
  18. 18.
    Gray DWR, Seabrook G, Dixon JM, et al. Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain? Ann R Coll Surg Engl. 1988;70:233–4.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Rizk MK, Tolba R, Kapural L, Mitchell J, Lopez R, Mahboobi R, Vrooman B, Mekhail N. Differential epidural block predicts the success of visceral block in patients with chronic visceral abdominal pain. Pain Pract. 2012;12:595–601.CrossRefGoogle Scholar
  20. 20.
    Veizi IE, Hajek S. Establishing diagnosis of chronic abdominal pain: pain medicine view. In: Kapural L, editor. Chronic abdominal pain: an evidence-based, comprehensive guide to clinical management. New York: Springer; 2015. p. 33–45.Google Scholar
  21. 21.
    Gachago C, Draganov PV. Pain management in chronic pancreatitis. World J Gastroenterol. 2008;14:3137–48.CrossRefGoogle Scholar
  22. 22.
    Olesen SS, Bouwense SA, Wilder-Smith OH, van Goor H, Drewes AM. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial. Gastroenterology. 2011;141:536–43.CrossRefGoogle Scholar
  23. 23.
    Olesen SS, Graversen C, Olesen AE, et al. Randomised clinical trial: pregabalin attenuates experimental visceral pain through sub-cortical mechanisms in patients with painful chronic pancreatitis. Aliment Pharmacol Ther. 2011;34:878–87.CrossRefGoogle Scholar
  24. 24.
    Bouwense SA, Buscher HC, van Goor H, Wilder-Smith OH. S-ketamine modulates hyperalgesia in patients with chronic pancreatitis pain. Reg Anesth Pain Med. 2011;36:303–7.CrossRefGoogle Scholar
  25. 25.
    Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol. 2013;11(3):208–16.CrossRefGoogle Scholar
  26. 26.
    Coulter ID, Favreau JT, Hardy ML, Morton SC, Roth EA, Shekelle P. Biofeedback interventions for gastrointestinal conditions: a systematic review. Altern Ther Health Med. 2002;8(3):76–83.PubMedGoogle Scholar
  27. 27.
    Humphreys P, Gevirtz R. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr. 2000;31:47–51.CrossRefGoogle Scholar
  28. 28.
    Bassotti G, Chistolini F, Sietchiping-Nzepa F, De Roberto G, Morelli A, Chiarioni G. Biofeedback for pelvic floor dysfunction in constipation. Br Med J. 2004;328(7436):393–6.CrossRefGoogle Scholar
  29. 29.
    Blanchard EB, Schwarz SP, Suls JM, Gerardi MA, Scharff L, Greene B, et al. Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther. 1992;30(2):175–89.CrossRefGoogle Scholar
  30. 30.
    Schwarz SP, Blanchard EB, Neff DF. Behavioral treatment of irritable bowel syndrome: a 1 year follow-up study. Biofeedback Self Regul. 1986;11(3):189–98.CrossRefGoogle Scholar
  31. 31.
    Kupers R, Faymonville ME, Laureys S. The cognitive modulation of pain: hypnosis and placebo induced analgesia. Prog Brain Res. 2005;150:251–69.CrossRefGoogle Scholar
  32. 32.
    Drossman DA, Toner BB, Whitehead WE. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional disorders. Gastroenterology. 2003;125:19–31.CrossRefGoogle Scholar
  33. 33.
    Sweiss G. In: Kapural L, editor. Chronic abdominal pain, an evidence-based comprehensive guide to clinical management. New York: Springer; 2015. p. 195–201.Google Scholar
  34. 34.
    Rathmell JP, Gallant JM, Brown DL. Computed tomography and the anatomy of celiac plexus block. Reg Anesth Pain Med. 2000;25:411–6.CrossRefGoogle Scholar
  35. 35.
    Badhey H, Jolly S, Kapural L. Bilateral splanchnic block at T11 provides longer pain relief than celiac plexus block from non-malignant abdominal pain. 2015 RAMP Supplement Abstr 145.Google Scholar
  36. 36.
    Prithvi Raj P, Sahinder B, Lowe M. Radiofrequency lesioning of splanchnic nerves. Pain Pract. 2002;2:241–7.CrossRefGoogle Scholar
  37. 37.
    Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg. 2005;75:640–4.CrossRefGoogle Scholar
  38. 38.
    Verhaegh BP, van Kleef M, Geurts JW, et al. Percutaneous radiofrequency ablation of the splanchnic nerves in patients with chronic pancreatitis: results of single and repeated procedures in 11 patients. Pain Pract. 2013;13(8):621–6.CrossRefGoogle Scholar
  39. 39.
    Buscher HC, Jansen JB, van Dongen R, Bleichrodt RP, van Goor H. Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Br J Surg. 2002;89:158–62.PubMedGoogle Scholar
  40. 40.
    Khan I, Raza S, Khan E. Application of spinal cord stimulation for the treatment of abdominal visceral pain syndromes: case reports. Neuromodulation. 2005;8:14–27.CrossRefGoogle Scholar
  41. 41.
    Kapural L. Neuromodulation for chronic visceral abdominal pain. In: Kapural L, editor. Chronic abdominal pain, an evidence-based comprehensive guide to clinical management. New York: Springer; 2015. p. 195–201.Google Scholar
  42. 42.
    Kapural L, Nagem H, Tlucek H, Sessler DI. Spinal cord stimulation for chronic visceral abdominal pain. Pain Med. 2010;11:347–55.CrossRefGoogle Scholar
  43. 43.
    Kapural L, Deer T, Yakovlev A, et al. Technical aspects of spinal cord stimulation for managing chronic visceral abdominal pain: the results from the national survey. Pain Med. 2010;11:685–91.CrossRefGoogle Scholar
  44. 44.
    Kapural L, Cywinski JB, Sparks DA. Spinal cord stimulation for visceral pain from chronic pancreatitis. Neuromodulation. 2011;14:423–6.CrossRefGoogle Scholar
  45. 45.
    Tea S. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology. 2008;134:1406–11.CrossRefGoogle Scholar
  46. 46.
    Mullhaupt B, Ammann RW. Total pancreatectomy for intractable pain in chronic pancreatitis? Pancreas. 2010;39:111–2.CrossRefGoogle Scholar
  47. 47.
    Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH, et al. Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg. 2012;147:925–32.PubMedGoogle Scholar
  48. 48.
    Negi S, Singh A, Chaudhary A. Pain relief after Frey’s procedure for chronic pancreatitis. Br J Surg. 2010;97:1087–95.CrossRefGoogle Scholar
  49. 49.
    Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003;35:553–8.CrossRefGoogle Scholar
  50. 50.
    Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007;356:676–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Leonardo Kapural
    • 1
  • Jeremy Naber
    • 1
  1. 1.Carolinas Pain Institute & Center for Clinical ResearchWinston-SalemUSA

Personalised recommendations