Visceral pain

Visceral pain is a complex and multifaceted experience, distinct from somatic pain due to its diffuse localisation, autonomic involvement, and strong affective components. It arises from internal organs and follows unique neurophysiological pathways, encompassing transduction, transmission, perception, modulation, and amplification. Visceral nociception is transmitted via autonomic afferents and ascends through the spinothalamic, spinoreticular, spinomesencephalic, and dorsal column pathways. The extensive convergence of visceral and somatic afferents contributes to referred pain and poses diagnostic challenges. Acute visceral pain is primarily nociceptive, triggered by inflammation, ischaemia, or distension, whereas chronic visceral pain involves central sensitisation, dysfunction of descending modulation, and neuroimmune activation, leading to persistent pain and visceral hypersensitivity. While simple analgesics, opioids, and regional anaesthesia techniques incorporating sympathetic blockade remain cornerstones of acute visceral pain treatment, chronic visceral pain management is more complex. It relies on a multidisciplinary approach, integrating pharmacotherapy, interventional techniques, physiotherapy, psychotherapy, lifestyle modifications, and patient education to support self-management, improve symptom control, and enhance function and quality of life.