Somatosensory Hypersensitivity in the Referred Pain Area in Patients With Chronic Biliary Pain and a Sphincter of Oddi Dysfunction: New Aspects of an Almost Forgotten Pathogenetic Mechanism

Kurucsai, G.; Joó, I; Fejes, R; Székely, A; Székely, Iván; Tihanyi, Zoltán; Altorjay, Áron; Funch‐Jensen, Peter; Várkonyi, Tamás; Madácsy, László

doi:10.1111/j.1572-0241.2008.02068.x

Cited by 28 publications

(13 citation statements)

References 21 publications

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“…[23,24] In this study, cutaneous sensorial alterations were detected in 18 patients. Cutaneous hypersensitivity was localized at dermatomes of the uterus and surrounding pelvic organs.…”

Section: Discussionmentioning

confidence: 99%

Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy

et al. 2016

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Chronic postsurgical pain (CPSP) is an important clinic problem. It is assessed that prevalence of chronic pain extends to 30% but it is contended that there are various risk factors. We aimed to evaluate the prevalence of chronic pain after hysterectomy, risk factors of chronicity, neuropathic features of pain, and sensorial alterations at surgery area.Between years 2012 and 2015, 16 to 65 ages old patients that electively undergone total abdominal hysterectomy bilateral salpingo-oophorectomy and passed minimum 3 months after surgery were included to study. Visual analog scale (VAS) and Douleur Neuropathique 4-questionnaire (DN-4) surveys were used to evaluate pain symptoms, algometry device was used for evaluating abdominal pressure threshold and Von Frey Filament was used for sensorial alterations.Ninety-three of 165 eligible patients were included to study. As the groups were compared by demographic data, no difference was obtained (P > 0.05). There was no difference between groups regarding patient and surgery attributes (P > 0.05). Most frequently performed incision type was Pfannenstiel. Neuropathic symptoms were observed in 90 patients (96.8%). Sensorial alterations as hypoesthesia and hyperesthesia were detected around abdominal scar in 18 patients (19.4%) with pinprick test.Neuropathic symptoms should not be ignored in studies evaluating CPSP and a standard methodology should be designed for studies in this topic.

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“…[23,24] In this study, cutaneous sensorial alterations were detected in 18 patients. Cutaneous hypersensitivity was localized at dermatomes of the uterus and surrounding pelvic organs.…”

Section: Discussionmentioning

confidence: 99%

Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy

et al. 2016

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“…The aetiology is believed to be multifactorial and include sphincter of Oddi dysfunction, bile duct stone, and other diseases; and thorough postoperative examination and treatment has been shown to significantly reduce the incidence. In many cases, however, the cause remains unknown, and visceral hyperalgesia and central sensitization have been suggested to be part of the pathophysiology [20,22].…”

Section: Introductionmentioning

confidence: 98%

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Blichfeldt-Eckhardt

Ørding

Andersen

et al. 2014

Pain

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Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1 week postoperatively, and 3, 6, and 12 months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12 months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week.

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“…Aside from manometry, the best predictor of response remains the Milwaukee classification, with type I being the most likely to respond (up to 70%-100%) and type III the least (equivalent to placebo) (Box 2). 57 However, note that this response is for biliary classification only and that pancreatic SOD, in the authors' opinion, has not undergone a comparable level of scrutiny. Chronic narcotic use, older age, gastroparesis, pain patterns, and pancreatic manometric pressures have been implicated as…”

Section: Predictors Of Responsementioning

confidence: 95%

“…A caveat to these results is that many patients with SOD III have underlying duodenal visceral hyperalgesia, psychosomatic disorders, and central sensitization, disorders that will not improve despite sphincter obliteration. 17,[55][56][57][58][59][60][61] Endoscopic therapy may also have a role for suspected pancreatic SOD type I and II. Sphincterotomy has been reported as efficacious at preventing future recurrent attacks for patients with idiopathic relapsing pancreatitis attributed to pancreatic SOD type I or II.…”

Section: Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%