Gastrointestinal Pain

GASTROINTESTINALPRIMEVIEW PAIN

For the Primer, visit doi:10.1038/s41572-019-0135-7

MANAGEMENT Gastrointestinal (GI) pain — a form of MECHANISMS Visceral visceral pain — is a common symptom primary of some GI disorders, such as Crohn’s afferents terminate In some cases, treating the underlying cause disease, chronic pancreatitis and at several levels of GI pain is sufficient for pain reduction. irritable bowel syndrome (IBS). Acute throughout the spinal However, pain-specific management can be pain is cord, which can, in part, required for some disorders, such as acute predominantly explain the diffuse pancreatitis. Although no pharmacological DIAGNOSIS conveyed to the spinal PCVWTGQH)+|RCKP therapies have been approved specifically for cord via visceral afferent fibres, specifically via GI pain, clinicians often use therapies that are GI pain is often initially poorly c-fibres and Aδ fibres, 8CICNȮDTGU approved for musculoskeletal or neuropathic localized, although the pain following which, the pain pain, such as NSAIDs, acetaminophen, presentation can change over signal is transmitted gabapentin, tricyclic antidepressants and time. For example, pain in acute to the brain serotonin–noradrenaline reuptake inhibitors. appendicitis is intially diffuse, but Sympathetic Of note, NSAIDs should be administered localizes to a specific region of the ȮDTGU Spinal with proton pump inhibitors in patients with abdomen (McBurney’s point) during later Enteric ȮDTGU GI disorders, owing to their effects on the stages of disease. In addition, GI pain can be ȮDTGU gut. Opioids can be used for severe GI pain referred to somatic structures, such as muscle but should be used with extreme caution or skin, and can be accompanied by autonomic owing to the high risk of dependence. Non- symptoms, such as diarrhoea, sweating and pharmacological treatments can be used in heart palpitations. The main aim of diagnosis some patients, such as endoscopy for those of GI pain is to identify and initiate treatment Visceral with obstruction of the biliary tree or main for the causative disorder. Diagnostic work-up CȭGTGPVU pancreatic duct, and surgery in some patients includes abdominal imaging (typically MRI or CT), with chronic pancreatitis. Autonomic Spinal laboratory tests (for symptoms cord example, assessing that accompany GI liver enzymes and pain can be caused QUALITY OF LIFE amylase levels) by the involvement of and assessment Somatic the enteric nervous CȭGTGPVU The of pain intensity system and vagal referral of Quality of life worsens with GI pain severity. using general pain fibres GI pain to somatic Chronic GI pain can be associated with several questionnaires. Pain factors that affect quality of life, such as functional Skeletal structures can partly can be classified as muscle be explained by the impairment, anxiety, depression, disturbed sleep primary pain (also convergence of visceral patterns and impaired cognition. known as functional and somatic nerve EPIDEMIOLOGY fibres in the spinal pain, whereby no Several questionnaires can be used to cord disease process assess quality of life in people with GI can be identified) Abdominal pain is common and disorders, such as inflammatory pain, including general questionnaires (such or secondary pain has been estimated to occur in up DQYGNFKUQTFGTU KPYJKEJŨ as the Short-Form Health Survey 36) and (caused by a specific to 25% of adults in community- of patients have abdominal malignancies (such as pancreatic VJQUGHQTURGEKȮE)+FKUQTFGTU UWEJCUVJG disease), and as based, cross-sectional studies, pain as a presenting symptom), cancer, in which abdominal Pancreatitis Quality of Life Instrument and acute or chronic although other studies have chronic pancreatitis (in which pain was reported as a primary the Irritable Bowel Syndrome-Quality of depending on reported different rates. Pain is most patients have pain during symptom in 44% of patients in Life Measure). KVU|FWTCVKQP associated with many different GI the course of disease) and one study). Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps. with regard neutral remains note: Springer Nature Publisher’s