If anything ail a man, so that he does not perform his functions, if he have a pain in his bowels even,—-for that is the seat of sympathy,—he forthwith sets about reforming—the world. - Henry David Thoreau (1817-1862)
There is almost no physician who has not encountered the problem of chronic visceral pain at some point in his or her career. Visceral and abdominal pain is a major clinical problem, affecting up to 25% of the general U.S. population. It may be part of a well-defined syndrome such as irritable bowel syndrome or chronic pancreatitis or be the sole or dominant clinical manifestation as in functional abdominal pain and dyspepsia. Patients with such pain present to a variety of medical specialists including gastroenterologists, cardiologists (noncardiac chest pain), gynecologists (pelvic pain syndromes) or urologists (interstitial cystitis etc.), anesthesiologists. The last two decades have seen impressive progress in the neurobiology of somatic pain and this is now beginning to be translated into clinical practice with the advent of several new classes of analgesics, particularly for neuropathic syndromes. By contrast, despite its prevalence, chronic visceral pain remains poorly understood, leading to significant difficulty in diagnosis and management. Much of modern medicine has tended to dismiss chronic visceral pain, in part because changes in function and structure of visceral organs are more subtle than those seen in somatic structures (a deformed and swollen knee for instance). Indeed, the term "functional pain'' is often used (pejoratively) for these patients, generally in association with a referral to a clinical psychologist.
The editors of this book feel fortunate and privileged to be able to assemble leading experts from across the world to write the first definitive and comprehensive work on this subject and one that is truly "bench to bedside.'' Conceptually, this book is divided into four sections. The first deals with a global overview of visceral pain, its distinctive features and social impact. The second section, written by many of the authors who have defined the paradigms in this field, provides a detailed discussion of the neurobiological, immunological, and psychological basis of visceral pain, as provided by the study of both animal models and human subjects. The next section deals with the growing array of molecular targets for treatment of visceral pain as well as current conventional and alternative approaches used in the clinic. The final section consists of a detailed discussion of individual syndromes covering the gamut of problems encountered by the practicing physician. In most instances, two leading authorities in the field have provided a state-of-the-art summary of the pathophysiology and management of these conditions, often bringing unique insight as well as practical tips.
The reader can approach this book in many different ways. For the novice clinician or researcher, if read as written, it will be an easily understood journey of discovery from basic anatomic and physiological principles to an understanding of the complex balance of patho-physiological factors that make up a given clinical syndrome and rational approaches to treatment of the same. For the expert, individual chapters can be perused with ease for an in-depth and up-to-date review of the topic. Either way, we are confident that the experience will be rewarding and stimulating.
It is clear that visceral pain syndromes are complex, possibly more so than their somatic counterparts. The editors of this book hope that we have been able to put together a compilation of work that will provide the beginning of a rational approach to this symptom and the recognition of the real suffering it causes.
Pain is real when you get other people to believe in it. If no one believes in it but you, your pain is madness or hysteria.- Naomi Wolf (b. 1962)
Pankaj Jay Pasricha William D. Willis G. F. Gebhart
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