Clinical Evaluation of Visceral Pain

  • Satish S. C. Rao


Because of rigorous efforts to characterize visceral pain, today, visceral hyperalgesia has emerged as the key mechanism for unexplained chest pain, unexplained abdominal pain, functional dyspepsia, and irritable bowel syndrome (1,2). Consequently, several innovative techniques have been developed both for evoking visceral pain and for identifying the locus of this problem. This chapter will focus on the methods that are currently available for the evaluation of visceral sensation and pain.


Irritable Bowel Syndrome Functional Dyspepsia Irritable Bowel Syndrome Patient Visceral Pain Balloon Distention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rao SSC. Visceral Hyperalgesia: The key for unraveling functional gastrointestinal disorders. Dig Dis 1996;14:271–275.PubMedCrossRefGoogle Scholar
  2. 2.
    Mayer, EA, Gebhart GF. Functional bowel disorders and the visceral hyperalgesia hypothesis. In: EA Mayer and HE Raybould (Eds.), Basic and Clinical Aspects of Chronic Abdominal Pain, Elsevier, Amsterdam, 1993, pp. 3–28.Google Scholar
  3. 3.
    Ritchie JA. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 1973;16:125–132.CrossRefGoogle Scholar
  4. 4.
    Sun WM, Edwards CA, Prior A, Rao SSC, Read NW. The effect of nicardipine on anorectal motility in normal human volunteers and in patients with irritable bowel syndrome. Dig Dis Sci 1990;35(7):885–890.PubMedCrossRefGoogle Scholar
  5. 5.
    Swarbrick CT, Bat T, Hegarty JE, Williams CB, Dawson AM. Site of pain from the irritable bowel. Lancet 1980;11:443–446.CrossRefGoogle Scholar
  6. 6.
    Richter JE, Barish CF, Castell DO. Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 1986;91:845–852.PubMedGoogle Scholar
  7. 7.
    Cannon RO, Cattau EL, Yakhe PN, Maher KM, Schenke WH, Benjamin SB, Epstein SE. Coronary flow reserve esophageal motility and chest pain in patients with angiographically normal coronary arteries. Am J Med 1990;88:217–222.PubMedCrossRefGoogle Scholar
  8. 8.
    Nevens F, Janssens J, Piessens J, Ghillebert G, DeGeest H, Vantrappen G. Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. Dig Dis Sci 1991; 36:229–235.PubMedCrossRefGoogle Scholar
  9. 9.
    Patel, R., Rao SSC: Esophageal biomechanical and sensory properties vary along its length. Am J Physiol 1998;275: G187–G191.PubMedGoogle Scholar
  10. 10.
    Sun WM, Read NW, Prior A, Daly J, Cheah K, Grundy D. Sensory and motor response to rectal distention vary according to rate and pattern of balloon inflation. Gastroenterology 1990; 99:1008–1015.PubMedGoogle Scholar
  11. 11.
    Rao SSC, Hayek B, Summers RW. Impedance planimetry: an integrated approach for assessing sensory, active and passive biomechanical properties of the human esophagus. Am J Gastroenterol 1995;90:431–438.PubMedGoogle Scholar
  12. 12.
    Gregersen H, Andersen MB. Impedance measuring system for quantification of cross-sectional area in the gastrointestinal trait. Med Biol Eng Comput 1991;29:108–110.PubMedCrossRefGoogle Scholar
  13. 13.
    Rao SSC, Gregersen H, Hayek B, Summers RW, Christensen J. Unexplained chest pain: The hypersensitive, hyperreactive, and poorly compliant esophagus. Ann Intern Med 1996; 124:950–958.PubMedGoogle Scholar
  14. 14.
    Gregersen H, Kassab G. Biomechanics of the gastrointestinal tract. Neurogastroenterol Mot 1996;8:1–20.CrossRefGoogle Scholar
  15. 15.
    Gregerson H, Orvar K, Christensen J. Biomechanical wall properties and tone during phase I and phase II of the MMC. Am J Physiol 1992; 263:G795–801.Google Scholar
  16. 16.
    Rasmussen OO, Sorensen M, Tetzschner T, Christiansen J. Dynamic anal manometry: Physiological variations and pathophysiological findings in fecal incontinence. Gastroenterology 1992;103:103–113.PubMedGoogle Scholar
  17. 17.
    Azpiroz F, Malagelada JR. Gastric tone measured by an electronic barostat in health and past surgical gastroparesis. Gastroenterology 1987;92:934–943.PubMedGoogle Scholar
  18. 18.
    Whitehead WE, Delvaux M. Standardization of procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal trait. Dig Dis Sci 1997; 42: 223–241.PubMedCrossRefGoogle Scholar
  19. 19.
    Delvaux M. The barostat: a tool to evaluate visceral sensitivity. In: Neurogastroenterology: Ed Corazziari E. Walter deGruyter, Berlin, N. York. 1996, pp. 115–133.Google Scholar
  20. 20.
    Mayrand S, Diamant NE. Measurement of human esophageal tone in vivo. Gastroenterology 1993; 105:1411–20.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Brien MD, Camilleri M, vonderOhe MR, Phillips SF, Pemberton JH, Prather CM, Wiste JA, Hanson RB. Motility and tone of the left colon in constipation: a role in clinical practice. 1996. 91:2532–2538.Google Scholar
  22. 22.
    Munakata J, Naliboff B, Harraf F, Kodner A, Lembo T, Chang L, Silverman DH, Mayer EA. Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome. Gastroenterology 1997;112:55–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Whitehead WE, Holtkotter B, Enck P, Hoelzl R, Holmes KD, Anthony J, Shabsin HS, Schuster MM. Tolerance for rectosigmoid distention in irritable bowel syndrome. Gastroenterology 1990;98:1187–1192.PubMedGoogle Scholar
  24. 24.
    Distrutti E, Soldevilla A, Azpiroz F, Malagelada JR. Gastric mechanoreceptors response characterized by a computerized tenso stat in humans. Gastroenterology 1996;110:A657.Google Scholar
  25. 25.
    Hammer HF, Phillips SF, Camilleri M, Hanson RB. Rectal tone, distensibility, and perception: reproducibility and response to different distensions. Am J Physiol 1998;274:G584–90.PubMedGoogle Scholar
  26. 26.
    Azpiroz F. Functional dyspepsia. In: Neurogastroenterology: Ed Corazziari E. WalterdeGruyter, Berlin, N. York, 1996, pp. 57–64.Google Scholar
  27. 27.
    Rao SSC, Welcher KD, Leistikow JS. Obstructive Defecation: A failure of rectoanal coordination. Am J Gastroenterol 1998;329:1905–11.Google Scholar
  28. 28.
    Lasch H, DeVault KR, Castell DO. Intraesophageal balloon distention in the evaluation of sensory thresholds: studies on reproducibility and comparison of balloon composition. Am J Gastroenterol 1994; 89:1185–1190.PubMedGoogle Scholar
  29. 29.
    Rogers J. Testing for and the role of anal and rectal sensation. In: Bailliere’s Clinical Gastroenterology: Ed Henry M. Bailliere Tindall (WB Saunders) London, UK, 1992; 6:179–191.Google Scholar
  30. 30.
    Loening V, Read NW, Yamada T. Cerebral evoked potentials after rectal stimulation. Electroenceph Clin Neurophysiol 1991;80–490–495.CrossRefGoogle Scholar
  31. 31.
    Accarino AM, Azpiroz F, Malagelada J-R: Selective dysfunction ofinechanosensitive intestinal afferents in the irritable bowel syndrome. Gastroenterology 1995;108:636–643.PubMedCrossRefGoogle Scholar
  32. 32.
    Rao SSC, and Schulze-Delrieu K. Normal gastrointestinal motility of stomach and duodenum. In: An illustrated guide to gastrointestinal motility. (2nd Edition) Kumar D and Wingate DL (Eds), Churchill Livingstone, London UK 1993, pp. 373–392.Google Scholar
  33. 33.
    Bernstein L. and Baker L. A clinical test for esophagitis, Gastroenterology 1958; 34:760–781.PubMedGoogle Scholar
  34. 34.
    Richter JE, Johns DN, Wu WC and Castell DO. Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test? JAMA 1985; 253:1914–1917.PubMedCrossRefGoogle Scholar
  35. 35.
    Hewson EG, Sinclair JW, Dalton CG, Wo WC, Castell DO and Richter JE. Acid Perfusion Test. Does it have a role in the assessment of noncardiac chest pain. Gut 1989;30:305–310.PubMedCrossRefGoogle Scholar
  36. 36.
    Rao SSC. Esophageal (NonCardiac) Chest Pain: Visceral Pain: Visceral hyperalgesia, reflux disorder or motor disorder. In: Visceral Pain, GF Gebhart (Ed), 1ASP Press, Seattle 1997, pp. 351–371.Google Scholar
  37. 37.
    Barbera R, Feinle C, Read NW. Abnormal sensitivity to duodenal lipid infusion in patients with functional dyspepsia. Eur Gastroenterol & Hep 1995; 7:1051–7.CrossRefGoogle Scholar
  38. 38.
    Barbera R, Feinle C. Read NW. Nutrient-specific modulation of gastric mechanosensitivity in patients with functional dyspepsia. Dig Dis & Sci 1995; 40:1636–41.CrossRefGoogle Scholar
  39. 39.
    Feinle C, Grundy D, Schwizer W, Fried M. Involvement of duodenal receptors in the induction of gastrointestinal (GI) sensations by gastric distension and duodenal lipid. Neurogastroenterol & Motil, 1998;10:A72.Google Scholar
  40. 40.
    Aziz Q, Thompson DG. Brain-gut axis in health and diseas. Gastroenterology 1998;114:559–578.PubMedCrossRefGoogle Scholar
  41. 41.
    Furlong PL, Aziz Q, Singh K, Holliday I, Barnes I, Harding GFA, Thompson DG. Localisation of cortical centres for human esophageal sensation using magnetoencephalography (abstr). Gastroenterology 1995;108:A726.CrossRefGoogle Scholar
  42. 42.
    Loening-Baucke V, Anderson RH, Yamada T, Zhu YX. Study of the afferent pathways from the rectum with a new distention control device. Neurology 1995;45:1510–1516.PubMedCrossRefGoogle Scholar
  43. 43.
    Loening-Baucke V, Yamada T. Is the afferent pathway from the rectum impaired in children with chronic constipation and encopresis? Gastroenterology 1995; 109–397–403.PubMedCrossRefGoogle Scholar
  44. 44.
    Aziz Q, Andersson JLR, Valind S, Sundin A, Hamdy S, Jones AKP, Foster ER, Langstrom B, and Thompson DG. Identification of human brain loci processing esophageal sensation using positron emission tomograph. J Gastroenterology 1997;113:50–59.CrossRefGoogle Scholar
  45. 45.
    Rosen SD, Paulesu E, Nihoyannopoulos P, Tousoulis D, Frackowiak RS, Frith CD, Jones T, Camici PG. Silent ischemia as a central problem: Regional brain activation compared in silent and painful myocardial ischemia. Ann Intern Med 1996;124:939–949.PubMedGoogle Scholar
  46. 46.
    Munakata J, Silverman DHS, Naliboff B, Matin K, Mayer EA. Anterior cingulate cortical activity levels during expected pain coorelate with sensitized rectal perception thresholds in IBS and healthy subjects. Gastroenterology 1997;112:A794.CrossRefGoogle Scholar
  47. 47.
    Enck P, Binkofski F, Schnitzler A, Aziz Q, Freiling T. Functional magnetic resonance brain imaging of the esophagus following distention. Neurogastroenterol & Motil 1998;10;69.Google Scholar
  48. 48.
    Sanger GJ. 5-Hydroxytryptamine and functional bowel disorder. Neurogastroentcrol Motil 1996; 8:319–331.CrossRefGoogle Scholar
  49. 49.
    Junien JL, Riviere P. The hypersensitive gut-peripheral kappa agonists as a new pharmalogical approach. Alim Phannacol & Therap 1995;9:117–126.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Satish S. C. Rao
    • 1
  1. 1.Department of Internal MedicineUniversity of Iowa College of MedicineIowa CityUSA

Personalised recommendations