Abstract
Introduction: Somatosensory hyperalgesia in the referred pain area (RPA) reported in patients with abdominal pain syndromes, which may result from convergence of nerve fibres from visceral and somatic tissue at spinal and supraspinal levels. Persistent hyperexcitability of neurons in the CNS may explain chronic biliary pain in PCS patients (i.e. biliary hypersensitivity) despite the original disease has been eliminated (cholecystectomy and sphincterotomy). The aim of the present study was to evaluate cutaneus neural sensibility in the referred pain area in PCS patients with persisting biliary pain before and after EST. Methods: Patients were asked to help the doctors assigning the RPA in the RUQ. The sensation threshold was than determined by Neurometer®CPT with transcutaneus electrical stimulator at frequencies of 5, 250, and 2000Hz, and at a current intensity range from 0.01 to 9.99 mA. The contralateral region of the abdomen (LUQ) was also measured, and represented the control area. Then the ratio of the sensation threshold between the RPA and the contra-lateral area was determined. Standardized questionnaire and visual analogue scale (VAS) were applied to assess PCS symptoms in all pts. Results: 10 pts with definite SOD before EST (VAS=6.8), and further 10 SOD pts with persisting biliary pain despite of previous complete EST (VAS=7.5), and 27 asymptomatic, healthy controls (VAS=0.2) were investigated. The measured sensitivity threshold ratios (LUQ/RPA) were 1.85 vs. 2.62 vs. 1.03 on 2000Hz; 2.18 vs. 2.72 vs. 0.98 on 250Hz; and 1.88 vs. 3.20 vs. 1.12 on 5Hz; respectively. Significant hypersensitivity in the RPA were detected in both pt groups vs. controls (p<0.0006 and p<0,0001). Conclusions: Continuous visceral pain – biliary pain – caused by local inflammatory/sensitizing processes or CNS malfunction could lead to significant hypersensitivity in SOD patients. Hypersensitivity could explain the persisting biliary pain after EST in these SOD patients.
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