Management issues in visceral pain

Visceral pain is pain that arises from, in, or around internal organs. Common examples include chest pain from cardiac muscle injury and functional abdominal pain. In populations with serious chronic illness, visceral pain is common. In those with cancer, for example, well-known visceral pain syndromes include pain from pancreatic cancer and bowel obstruction. Recent advances have increased our understanding of the diagnostic challenges and therapeutic possibilities for patients with visceral pain syndromes. Understanding the basis of referred pain is a key component of patient assessment. The complexity of visceral nociception and pain signalling is being unravelled through anatomical, immunohistochemical, imaging, and functional studies. On a molecular level, families of receptors have now been described that will lead to a future with innovative therapies. This knowledge has developed within the paradigms of pain pathways, peripheral activation, and peripheral and central sensitization, thereby linking and distinguishing visceral pain from somatic and neuropathic pain. Treatment options for visceral pain encompass a wide variety of medical, interventional, and psychological approaches. Appropriate diagnostic measures and careful consideration of therapeutic options are needed to optimize patient outcomes.