Emerging therapies and novel approaches to visceral pain

Abstract

Visceral pain is the most common type of pain associated with disease and is one of the most frequent reasons why patients present to a doctor's office. Although these patients seek medical care because they are looking for help to alleviate their visceral discomfort and pain, in clinical practice much emphasis has been placed on finding a specific etiology and specific pathological markers for visceral disease. These patients typically undergo many diagnostic tests and procedures. However, often the examination and work-up remain unrevealing and no specific cause of the pain can be identified. In these cases it is important to recognize that pain is not only a symptom of visceral disease, but that the patient is suffering from a ‘chronic visceral pain syndrome’. Although visceral pain is very common, the recognition of chronic visceral pain as a chronic pain syndrome is fairly new in the clinical subspecialties of gynecology, urology, gastroenterology and cardiology. Much of what we know about the pathophysiological mechanisms of pain is derived from experimental studies of somatic and not visceral nociception. Traditionally it was assumed that visceral pain is simply a variant of somatic pain; however, there is growing evidence that, although there are some similarities between the mechanisms of visceral and somatic pain, there are also very important differences. The purpose of this article is to provide a concise update on the epidemiological and clinical aspects of the visceral pain syndromes, which present an unmet medical need, and to discuss recent advances in the understanding of the pathophysiological mechanisms of visceral pain, highlighting where novel therapeutic approaches might emerge in the near future.