Somatosensory changes in the referred pain area before and after cholecystectomy in patients with uncomplicated gallstone disease

Stawowy, Marek; Drewes, Asbjørn Mohr; Arendt-Nielsen, Lars; Funch‐Jensen, Peter

doi:10.1080/00365520500463332

Cited by 20 publications

(8 citation statements)

References 25 publications

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“…In a study by Stawowy et al [31], in patients with uncomplicated gallstone disease before cholecystectomy, hypersensitivity was present only in subgroups of patients, but not on whole-group level, the most significant differences being hypersensitivity to electrical stimuli, which were not used in our study. Regarding the QST findings after 6 and 12 months, 2 follow-up studies on postoperatively pain-free patients showed no signs of hypersensitivity [21,30], thus supporting our findings. A study by Kurucsai et al [22] on patients with postcholecystectomy syndrome, tested with electrical stimuli, reported significant hypersensitivity in the RPA.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Blichfeldt-Eckhardt

Ørding

Andersen

et al. 2014

Pain

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“…In addition, patients with GERD and NCCP also demonstrate increased areas of referred esophageal pain compared with healthy controls (6,7). In a well-designed study in patients pre-and postcholecystectomy, the authors showed that prior to surgery, 84% of patients had somatosensory hyperalgesia in the area of referred pain which resolved within 4 -12 wk following surgery (31).…”

Section: Discussionmentioning

confidence: 96%

“…Drewes and colleagues (5)(6)(7)31) have performed many studies looking at referred visceral pain both in health and in patients with conditions that include gastroesophageal reflux disease (GERD), noncardiac chest pain (NCCP), pancreatitis, and gallstone disease. In studies of healthy subjects it has been shown that sensitization of the esophagus with either dilute acid or capsaicin results in the expansion of the area of referred esophageal pain elicited by thermal, mechanical, and electrical stimulation (1,24).…”

Section: Discussionmentioning

confidence: 99%

Neurophysiological evaluation of convergent afferents innervating the human esophagus and area of referred pain on the anterior chest wall

Hobson

Chizh

Hicks

et al. 2010

American Journal of Physiology-Gastrointestinal and Liver Physi

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Noxious stimuli in the esophagus cause pain that is referred to the anterior chest wall because of convergence of visceral and somatic afferents within the spinal cord. We sought to characterize the neurophysiological responses of these convergent spinal pain pathways in humans by studying 12 healthy subjects over three visits (V1, V2, and V3). Esophageal pain thresholds (Eso-PT) were assessed by electrical stimulation and anterior chest wall pain thresholds (ACW-PT) by use of a contact heat thermode. Esophageal evoked potentials (EEP) were recorded from the vertex following 200 electrical stimuli, and anterior chest wall evoked potentials (ACWEP) were recorded following 40 heat pulses. The fear of pain questionnaire (FPQ) was administered on V1. Statistical data are shown as point estimates of difference +/- 95% confidence interval. Pain thresholds increased between V1 and V3 [Eso-PT: V1-V3 = -17.9 mA (-27.9, -7.9) P < 0.001; ACW-PT: V1-V3 = -3.38 degrees C (-5.33, -1.42) P = 0.001]. The morphology of cortical responses from both sites was consistent and equivalent [P1, N1, P2, N2 complex, where P1 and P2 are is the first and second positive (downward) components of the CEP waveform, respectively, and N1 and N2 are the first and second negative (upward) components, respectively], indicating activation of similar cortical networks. For EEP, N1 and P2 latencies decreased between V1 and V3 [N1: V1-V3 = 13.7 (1.8, 25.4) P = 0.02; P2: V1-V3 = 32.5 (11.7, 53.2) P = 0.003], whereas amplitudes did not differ. For ACWEP, P2 latency increased between V1 and V3 [-35.9 (-60, -11.8) P = 0.005] and amplitudes decreased [P1-N1: V1-V3 = 5.4 (2.4, 8.4) P = 0.01; P2-N2: 6.8 (3.4, 10.3) P < 0.001]. The mean P1 latency of EEP over three visits was 126.6 ms and that of ACWEP was 101.6 ms, reflecting afferent transmission via Adelta fibers. There was a significant negative correlation between FPQ scores and Eso-PT on V1 (r = -0.57, P = 0.05). These data provide the first neurophysiological evidence of convergent esophageal and somatic pain pathways in humans.

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“…The effects of cholecystectomy on central sensitization have been explored in non-fibromyalgic subjects in previous studies. Stawowy et al [ 32 ] applied quantitative sensory testing in the referred pain area from the gallbladder (upper abdominal quadrant) and in a control area on the contralateral side of the abdomen before and 4–12 weeks after surgery, while Kjaer et al [ 33 ] performed a similar study evaluating the somatosensory changes 2–7 years after laparoscopic cholecystectomy. In both cases the initial hypersensitivity of the referred area returned to normal in the follow-up period, also in patients who developed postcholecystectomy syndrome.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization

et al. 2016

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Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1week, 1,3,6 and 12months after laparoscopic cholecystectomy in fibromyalgia patients with symptomatic calculosis (n = 31) vs calculosis patients without fibromyalgia (n. 26) and at comparable time points in fibromyalgia patients not undergoing cholecystectomy, with symptomatic (n = 27) and asymptomatic (n = 28) calculosis, and no calculosis (n = 30). At basis, fibromyalgia+symptomatic calculosis patients presented a significant linear correlation between the number of previously experienced biliary colics and fibromyalgia pain (direct) and muscle thresholds (inverse)(p<0.0001). After cholecystectomy, fibromyalgia pain significantly increased and all thresholds significantly decreased at 1week and 1month (1-way ANOVA, p<0.01-p<0.001), the decrease in muscle thresholds correlating linearly with the peak postoperative pain at surgery site (p<0.003-p<0.0001). Fibromyalgia pain and thresholds returned to preoperative values at 3months, then pain significantly decreased and thresholds significantly increased at 6 and 12months (p<0.05-p<0.0001). Over the same 12-month period: in non-fibromyalgia patients undergoing cholecystectomy thresholds did not change; in all other fibromyalgia groups not undergoing cholecystectomy fibromyalgia pain and thresholds remained stable, except in fibromyalgia+symptomatic calculosis at 12months when pain significantly increased and muscle thresholds significantly decreased (p<0.05-p<0.0001). The results of the study show that biliary colics from gallbladder calculosis represent an exacerbating factor for fibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of their treatment on fibromyalgia pain/hypersensitivity.

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Somatosensory changes in the referred pain area before and after cholecystectomy in patients with uncomplicated gallstone disease

Abstract: Uncomplicated gallstone disease leads to significant hyperalgesia in the somatic referred pain area. At the time of the postoperative investigation none of the patients suffered from pain, which was reflected in the normal sensory findings in the previous referred pain area.

Cited by 20 publications

References 25 publications

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Neurophysiological evaluation of convergent afferents innervating the human esophagus and area of referred pain on the anterior chest wall

Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization

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