Referred Pain Hyperalgesia and Viscero Viscerar Interactions

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In the clinical context, it is common to observe that algogenic conditions may affect simultaneously more than one internal organ in the same patient. Especially when two viscera are involved, which share at least part of their central sensory projection, this circumstance gives rise to the so-called phenomenon of ''viscero-visceral hyperalgesia,'' due to which the patient experiences an enhancement of both spontaneous referred pain and referred hyperal-gesia (22). The concomitant presence of coronary heart disease and gallbladder calculosis, for instance, tends to produce more numerous anginal attacks and biliary colics in the patients than does one condition only (common sensory projection between heart and gallbladder: T5) (24). The association of dysmenorrhea with IBS (common projection between uterus and colon: T10-L1) (25) frequently produces more menstrual pain, intestinal pain, and somatic abdominal/pelvic hyperalgesia (in the areas of referral from the uterus and from the intestine) than dysmenorrhea or IBS only (unpublished observation). Dysmenorrhea/endometriosis combined with urinary calculosis in the same patient (common projection between uterus and upper urinary tract: T10-L1) (25) has been shown to produce increased menstrual pain,

BILIARY COLIC Referred trophic changes

Figure 2 Referred trophic changes in subcutis (increased thickness) and muscle (decreased thickness) measured via ultrasounds at the cystic point (black column) and contralateral side (white column) in patients with symptomatic gallbladder calculosis. Asterisks refer to comparison between the two sides. Source: From Ref. 19.

Figure 2 Referred trophic changes in subcutis (increased thickness) and muscle (decreased thickness) measured via ultrasounds at the cystic point (black column) and contralateral side (white column) in patients with symptomatic gallbladder calculosis. Asterisks refer to comparison between the two sides. Source: From Ref. 19.

urinary colic pain, and somatic abdomino-pelvic/lumbar hyperalgesia (in the areas of referred pain from the uterus and from the urinary tract), with respect to one condition only (18). The phenomenon of "viscero-visceral hyperalgesia'' has important therapeutic implications. Effective treatment of one condition, in fact, may significantly improve typical symptoms from the other, e.g., decrease in urinary pain and referred hyperalgesia at lumbar level after hormonal treatment of dysmenorrhea or decrease in menstrual pain and referred abdomino-pelvic hyperalgesia after urinary stone elimination following lithotripsy (18,22).

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