Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology

Abstract

The relationship was investigated between algogenic potential of gallbladder pathology and occurrence/extent of sensory and trophic changes in the referred area. Five groups of subjects were studied, with: symptomatic gallbladder calculosis (3-20 colics); asymptomatic calculosis; symptomatic gallbladder shape abnormality (8-18 colics); asymptomatic shape abnormality; normal gallbladder/no symptoms. At the cystic point (CP) and contralaterally, all underwent measurement of: pain thresholds to electrical stimulation of skin, subcutis and muscle; thickness of subcutis and muscle via ultrasounds. Contralaterally to CP, all thresholds were not significantly different in the five groups. At CP, subcutis and muscle thresholds were significantly lower in symptomatic vs asymptomatic patients and/or normals (0.0001<P< 0.05). In symptomatic cases, at CP compared to contralaterally, subcutis and muscle thresholds were significantly lower (0.0001<P<0.02), subcutis thickness was significantly higher and muscle thickness significantly lower (0.006<P<0.02). Subcutis and muscle thresholds at CP in symptomatic patients were significantly and inversely correlated linearly to the number of colics (P<0.0004; P<0.0001). Patients with symptomatic calculosis were re-evaluated after 6 months; those not presenting further colics showed a significant increase in subcutis and muscle thresholds at CP, while those who continued presenting colics showed a further significant threshold decrease (0.01<P<0.05); tissue thickness did not vary. Referred hyperalgesia and altered trophism from the gallbladder only occur in painful pathology, their extent being modulated by the amount of perceived pain. The results suggest different mechanisms by which visceral nociceptive inputs trigger sensory vs trophic changes in the referred area.

Myofascial Dysfunction and Its Relationship to Laparoscopy

“…The duration of pain and number of laparoscopies significantly predicted the number of areas of trigger points 91 . These findings would suggest that in a similar mechanism to the gall bladder, the extent of pain is an important factor in the genesis of chronic pelvic pain due to myofascial trigger points 83 . Also, the presence of laparoscopy as a predictor of the number of areas of trigger points could be considered another proxy for the duration of pain but it also suggests that the surgical procedure itself might affect ongoing pain experience.…”

“…On important aspect of the physiology of viscero-somatic pain referral has been undertaken in relation to the gall bladder. Diseases of the gall bladder were found to produce changes in pain thresholds in the skin, subcutaneous tissues and muscle, reduction in muscle thickness and cutaneous allodynia on the side of the gall bladder when compared to the contralateral side 83 . There was a direct negative correlation between the number of colicky aspects and the measurement of pain threshold.…”

A Paradigm-Shift in Pain Medicine

“…Acute pain typically results in descending inhibitory modulation to the skin -if this inhibitory system is intact, which may not always the case in chronic pain patients 35,46,230,244 . The fact that in our study of low back pain patients (V), acute sciatica was related to higher pain thresholds suggests that in these relatively short-duration chronic pain patients, descending inhibitory modulation was still intact, although we did not formally test this, e.g.…”

“…Note that modulation can be either inhibitory or facilitatory. A central question in chronic pain is whether the central sensitisation present is still dependent for its persistence on ongoing caudal nociceptive inputs visceral pain 230,260 . On the other hand, in both low back pain patients (which have generalised muscle hyperalgesia 45 ) and "cold" CRPS I patients (which also exhibit muscle hyperalgesia 277 ), some form of generalised cutaneous hyperalgesia to electrical stimulation was present in our studies (V, VII).…”

Illustrationen zum übertragenen Schmerz

“…als "visceral referred pain" beschrieben. Die Relevanz dieses Phänomens zeigt sich in der Häufigkeit von chronischen Bauchschmerzen oder chronischen Beckenschmerzen der Frau, die in verschiedenen Bevölkerungs-umfragen von etwa 15-20% der Befragten als wiederkehrende Beschwerdesymptomatik angegeben wurden [25,28].Während experimentelle Studien zum übertragenen Schmerz seit den späten 1990er Jahren wieder vermehrt ins Interesse der Schmerzforschung gerückt sind [5,6,27], gab es bei den klinischen Studien hingegen seit den 1920er Jahren fast keine nennenswerten neuen Arbeiten. Weiterhin ist zu bemerken, dass viele Ergebnisse nur auf nationaler Ebene und nichtenglischsprachig veröffentlicht wurden, sodass sie entsprechend in der medizinischen Literatur nur sehr selten oder gar nicht zitiert werden.…”