Esophageal sensation in spinal cord-injured patients: balloon distension and cerebral evoked potential recording

DeVault, Kenneth R.; Beacham, Sabrina; Do, Castell; Streletz, Leopold J.; Ditunno, Jr Jf

doi:10.1152/ajpgi.1996.271.6.g937

Cited by 18 publications

(14 citation statements)

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“…A second study provides the strongest evidence in support of the concept that vagal afferent fibers mediate esophageal afferent sensation. Studies on patients with spinal cord injuries with complete transection at the C6-7 levels done by DeVault et al [80] demonstrate an intact perception to IEBD in these patients which was similar to the response obtained in healthy control subjects.…”

Section: Afferent Transmissionsupporting

confidence: 78%

Recent developments in chest pain of undetermined origin

Achem

2000

Curr Gastroenterol Rep

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The syndrome of angina-like pain with normal epicardial coronary vessels is a very common and expensive clinical problem. Patients suffering from this condition frequently present a diagnostic challenge. Cardiac and musculoskeletal disorders must be excluded prior to identifying the esophagus as the source of pain. The term "chest pain of undetermined origin" (UCP) has been proposed to refer to this condition. Esophageal dysmotility was previously considered a major source for chest pain; however, recent studies indicate that esophageal reflux is the most common cause of esophageal pain. Two controlled trials of acid suppressive agents in patients with chest pain have shown that omeprazole provides effective pain relief for the majority of these individuals. Visceral hyperalgesia and psychologic disturbances are also commonly noted in patients with UCP. Much remains to be learned about the etiology of visceral hyperalgesia and the precise role of psychologic abnormalities in these patients. Until further information is available, treatment with imipramine or trazodone has been shown to offer effective relief of chest pain for subgroups of patients with UCP. Psychologic intervention is also valuable in the management of some patients. Studies of other therapeutic regimens continue to be conducted.

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Section: Afferent Transmissionsupporting

confidence: 78%

Recent developments in chest pain of undetermined origin

Achem

2000

Curr Gastroenterol Rep

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“…8 9 Innervation of the oesophagus is more complex than the remaining parts of the gut as the upper third is innervated by somatic afferents and, furthermore, sensations may to some degree be mediated by non-spinal afferents. 10 In the central nervous system (CNS), oesophageal afferents converge on a large scale with neurones receiving input from superficial and deep somatic tissue resulting in referred pain to somatic structures. 11 Increased acid exposure of the oesophagus may lead to sensitisation of the nerves resulting in plastic changes not only on peripheral nerves but also in the CNS.…”

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confidence: 99%

Multimodal pain stimulations in patients with grade B oesophagitis

Drewes

Reddy²,

Pedersen³

et al. 2006

Gut

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Aim: To obtain a better understanding of nociceptive processing in patients with oesophagitis. Patients and methods: Eleven patients with grade B oesophagitis were compared with an age and sex matched group of 16 healthy subjects. A probe was positioned in the lower part of the oesophagus. After preconditioning of the tissue, painful mechanical stimuli were applied as distensions with a bag using an impedance planimetric method. Distensions were done before and after pharmacological impairment of distension induced smooth muscle contractions. Thermal stimulation was performed by recirculating water at 1 and 60˚C in the bag. The area under the temperature curve (AUC) represented caloric load. The referred pain area (being a proxy for the central pain mechanisms) to the mechanical stimuli was drawn at maximum pain intensities. Results: Patients were hyposensitive to mechanical stimuli, as assessed by the distending volume (F = 8.1, p = 0.005). After relaxation of smooth muscle with butylscopolamine, the difference between the two groups was more evident (F = 27.4, p,0.001). AUC for cold stimulation was 1048.6 (242.7)˚C6s in controls and 889.8 (202.6)˚C6s in patients (p = 0.5). For heat stimuli, AUC values were 323.3 (104.1) and 81.3 (32.3)˚C6s in controls and patients, respectively (p = 0.04). The referred pain area to the mechanical stimulations was larger and more widespread in patients (49.3 (6.2) cm 2 compared with controls 23.9 (7) cm 2 ; p = 0.02). Conclusions:The data indicate that peripheral sensitisation of heat sensitive receptors and pathways combined with facilitation of central pain mechanisms may explain the symptoms in patients with oesophagitis.

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“…There is experimental and clinical evidence to support a role of the vagus nerve in pain perception. Esophageal distension triggered pain in patients with cervical spinal cord transsection, which could be partly confounded by the more rostral projections of spinal esophageal afferents innervating the proximal esophagus [30]. Acute illnesses from appendicitis to cholecystitis may be more difficult to diagnose, but are still associated with abdominal pain in paraplegic individuals with thoracic or cervical lesions [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Pain without nociception?

Levinthal

Bielefeldt²

2012

European Journal of Gastroenterology & Hepatology

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We describe a young woman with complete cervical spinal cord transsection, who developed significant abdominal pain, triggered by gastric distension and deep abdominal palpation. On the basis of the nature of her spinal cord injury, her brain-gut axis was limited to vagal pathways. Studies in mammalian models of human visceral sensation consistently showed that the subdiaphragmatic vagus contains a homogeneous population of afferents that are activated by low-intensity stimuli, which are generally believed to be important in regulating autonomic function and perhaps contributing to visceral sensory experiences triggered by such low-intensity stimuli (e.g. fullness, nausea), but not pain, although many fibers encode stimuli well into the noxious range. In contrast, spinal afferent pathways include fibers with high-activation thresholds that are thought to represent specialized nociceptors. This illustrative case argues against an exclusive role of specialized nociceptive pathways in visceral pain, but supports a concept of intensity coding with the composite of vagal and spinal input contributing to conscious perception and pain.

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Esophageal sensation in spinal cord-injured patients: balloon distension and cerebral evoked potential recording

Cited by 18 publications

References 0 publications

Recent developments in chest pain of undetermined origin

Recent developments in chest pain of undetermined origin

Multimodal pain stimulations in patients with grade B oesophagitis

Pain without nociception?

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