Visceral Pain

Defining Visceral Pain

Visceral pain refers to pain that originates from the internal organs, such as the stomach, intestines, uterus, liver, or kidneys. 

This type of pain is often described as a deep, dull ache or a cramping sensation and can be difficult to localise or pinpoint to a specific area. 

Visceral pain is typically caused by the activation of pain receptors (nociceptors) in the internal organs due to inflammation, stretching, or pressure.

It can be accompanied by other symptoms such as nausea, vomiting, or changes in bowel habits. 

Visceral pain is often less localised and more diffuse compared to other types of pain, such as somatic or neuropathic pain.

Where Does Visceral Pain Occur?

Visceral pain occurs within the internal organs of the body, which include organs such as the stomach, intestines, liver, kidneys, bladder, uterus, and others.

These organs are located within the abdomen (belly) and pelvis, as well as in the thoracic (chest) cavity. 

Therefore, visceral pain occurs in the midsection — the abdomen, pelvis, and chest, depending on which internal organ is affected. 

Sometimes, visceral pain can be felt in areas distant from the affected organ due to the way nerve signals are processed in the body, a phenomenon known as referred pain.

What Causes Visceral Pain?

Visceral pain can be caused by a variety of factors, including:

• Inflammation. Inflammatory conditions affecting the internal organs, such as gastritis (inflammation of the stomach lining), pancreatitis (inflammation of the pancreas), or inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), can lead to visceral pain.
• Stretching or Distension. When the internal organs are stretched or distended beyond their normal capacity, it can trigger pain sensations. This may occur due to conditions such as intestinal obstruction, bloating, or urinary retention.
• Ischaemia. Reduced blood flow to the internal organs, known as ischaemia, can cause visceral pain. Conditions such as myocardial infarction (heart attack), mesenteric ischaemia (reduced blood flow to the intestines), or renal infarction (lack of blood supply to the kidneys) can lead to ischaemic visceral pain.
• Spasms. Spasms or contractions of the smooth muscles within the internal organs can cause visceral pain. Conditions such as gallbladder or kidney stones, urinary tract spasms, or uterine contractions during menstruation can result in spasmodic visceral pain.
• Tumours. Benign or malignant tumours within the internal organs can compress surrounding tissues, nerves, or blood vessels, leading to visceral pain. Examples include pancreatic cancer, liver tumours, or ovarian cysts.
• Infections. Bacterial, viral, or parasitic infections affecting the internal organs can cause inflammation and irritation, resulting in visceral pain. Conditions such as urinary tract infections, appendicitis, or pelvic inflammatory disease may lead to visceral pain.
• Nerve Damage. Damage to the nerves that supply the internal organs, known as visceral neuropathy, can cause abnormal pain sensations. This can occur due to conditions such as diabetic neuropathy affecting the gastrointestinal tract or nerve damage from conditions like interstitial cystitis.
• Postoperative Pain. Pain experienced after surgical procedures involving the internal organs is termed postoperative visceral pain. It can result from tissue trauma, inflammation, or nerve irritation during surgery.

These are just a few examples of the many potential causes of visceral pain.

Proper diagnosis by a healthcare professional with experience in treating chronic pain is essential to determine the underlying cause and ensure appropriate treatment.

What is a Visceral Pain Specialist?

A visceral pain specialist is a physician who specialises in diagnosing and treating conditions related to visceral pain, which originates from the internal organs of the body. 

These specialists typically have extensive knowledge and expertise in identifying the underlying causes of visceral pain, which can range from gastrointestinal disorders to urological conditions. 

They employ a variety of diagnostic techniques and treatment modalities, such as medication management, interventional procedures, and multidisciplinary approaches, to help alleviate pain and improve the quality of life for patients experiencing visceral pain.

Multidisciplinary Teams for Visceral Pain Management

Chronic visceral pain is often best treated by a multidisciplinary team that includes various healthcare professionals with expertise in different fields relevant to the diagnosis and management of visceral pain. 

Here a few types of pain management professionals and how they work with patients dealing with visceral pain:

• Gastroenterologists. Specialise in disorders of the digestive system, including conditions such as gastritis, inflammatory bowel disease, and pancreatic disorders, which can cause visceral pain.
• Urologists. Focus on conditions affecting the urinary tract and male reproductive system, such as kidney stones, urinary tract infections, and interstitial cystitis, which may lead to visceral pain.
• Gynaecologists: Specialise in women’s reproductive health and may be involved in managing conditions like endometriosis, ovarian cysts, or pelvic inflammatory disease, which can cause visceral pain.
• Pain management specialists. Physicians with expertise in managing various types of pain, including visceral pain. They may utilise medications, nerve blocks, spinal cord stimulation, or other interventional procedures to alleviate pain.
• Physical therapists. Help patients improve mobility, strength, and function through targeted exercises and therapeutic techniques, which can be beneficial in managing visceral pain, especially in cases involving musculoskeletal components or rehabilitation after surgery.
• Psychologists or psychiatrists. Assist patients in coping with the emotional and psychological aspects of chronic pain, such as stress, anxiety, and depression, which often accompany visceral pain conditions.
• Radiologists. Interpret imaging studies (e.g., ultrasound, CT scans, MRI) to aid in the diagnosis and assessment of visceral pain-related conditions, providing valuable information for treatment planning.
• Nutritionists or Dietitians. Offer dietary guidance and nutritional counselling to manage conditions like irritable bowel syndrome (IBS) or gastritis, which can contribute to visceral pain symptoms.
• Hypnotherapists. Assist in management of bowel disorders such as irritable bowel syndrome and gut dysfunction.

By working collaboratively within a multidisciplinary team, Dr Mittal can provide comprehensive care that addresses the varied needs of patients experiencing visceral pain, aiming to improve their quality of life and functional outcomes.

How Does a Pain Specialist Treat Visceral Pain?

A chronic pain specialist may employ various techniques to treat visceral pain, depending on the underlying cause and individual patient needs. 

Some common approaches include:

• Medications. Pain specialists may prescribe medications to alleviate visceral pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (sparingly in specific situations only due their side effect profile), antispasmodics, antidepressants, or anticonvulsants. These medications can help reduce inflammation, block pain signals, alleviate muscle spasms, or modulate nerve function.
• Interventional Procedures. Pain specialists may perform interventional procedures to target specific nerves or areas associated with visceral pain. Examples include nerve blocks, epidural injections, neurolytic blocks, or radiofrequency ablation, which aim to interrupt pain signals and provide relief.
• Neuromodulation. Neuromodulation techniques, such as spinal cord stimulation or peripheral nerve stimulation, involve implanting devices that deliver electrical impulses to modulate nerve activity and alleviate pain. These techniques can be effective in managing chronic visceral pain that is refractory to other treatments.
• Physical Therapy. Pain specialists may refer patients to physical therapists who specialise in techniques to improve mobility, strength, and function. Physical therapy modalities such as exercise programs, and relaxation techniques can help reduce pain and improve overall well-being in individuals with visceral pain.
• Psychological Interventions. Pain specialists may recommend psychological interventions, such as cognitive-behavioural therapy (CBT), biofeedback, or relaxation techniques, to help patients cope with the emotional and psychological aspects of chronic pain. These interventions can address factors such as stress, anxiety, depression, and maladaptive pain behaviours, which may contribute to the experience of visceral pain.
• Lifestyle Modifications. Pain specialists may advise patients to make lifestyle modifications to manage visceral pain, such as adopting a healthy diet, maintaining a regular exercise routine, managing stress, improving sleep hygiene, and avoiding triggers that exacerbate pain symptoms.

Treating visceral pain properly necessitates a customised approach and may involve a combination of these techniques. 

Collaboration between the pain specialist, the patient, and other healthcare providers is essential to develop a comprehensive treatment plan aimed at optimising pain relief and improving quality of life.

The Challenges of Living with Chronic Visceral Pain

Living with chronic visceral pain presents numerous challenges that can significantly impact an individual’s physical, emotional, and social well-being, such as:

• Diagnostic Difficulties. Visceral pain can be challenging to diagnose accurately due to its diffuse nature and the complex interplay of various internal organs. This can lead to delays in receiving a definitive diagnosis and appropriate treatment, prolonging the pain experience.
• Persistent Discomfort. Chronic visceral pain often manifests as a constant, deep ache or intermittent sharp pains within the abdomen, pelvis, or chest. This persistent discomfort can be debilitating, making it difficult to perform daily activities, concentrate, or sleep well.
• Limited Mobility. Visceral pain can impair mobility and physical functioning, affecting one’s ability to engage in routine tasks, exercise, or participate in social and recreational activities. This loss of mobility can contribute to feelings of frustration, isolation, and dependency on others.
• Emotional Distress. Living with chronic visceral pain can take a toll on emotional well-being, leading to feelings of anxiety, depression, irritability, or mood swings. Coping with the uncertainty of pain flare-ups, the impact on quality of life, and the challenges of managing symptoms can exacerbate psychological distress.
• Social Isolation. Chronic visceral pain may disrupt social interactions and relationships, as individuals may withdraw from social gatherings, work, or other activities due to pain-related limitations. Feelings of isolation, loneliness, and stigma associated with invisible illnesses can further exacerbate emotional distress.
• Impact on Daily Functioning. The debilitating nature of visceral pain can affect various aspects of daily life, including work, household chores, childcare responsibilities, and self-care tasks. This disruption to normal routines can lead to feelings of frustration, helplessness, and loss of identity.
• Financial Burden. Managing chronic visceral pain often entails ongoing medical expenses, including doctor’s visits, diagnostic tests, medications, and treatments. Additionally, individuals may experience loss of income due to disability, reduced work productivity, or job loss, leading to financial strain and insecurity.
• Side Effects of Treatment. Some treatments for chronic visceral pain, such as medications or interventional procedures, may be associated with adverse side effects or risks. Balancing the potential benefits of treatment with the risks and side effects can pose additional challenges for individuals managing chronic pain.

Overall, living with chronic visceral pain requires resilience, adaptability, and a multidisciplinary approach that addresses the physical, emotional, and social aspects of pain management. 

Effective strategies for coping with chronic pain may include pain education, self-management techniques, social support, psychological interventions, and holistic approaches to improve overall well-being and quality of life.

How do I Find a Visceral Pain Specialist Near Me?

To find a doctor or specialist who treats chronic visceral pain near you, start by asking for referrals from your general practitioner or other healthcare professionals that you’ve seen. 

Often, physicians in related fields have pain management doctors they work with, so they may be able to recommend specialists in your area based on your specific needs.

Your general practitioner may also be able to give you a referral. 

Additionally, you can search online using reputable healthcare provider directories or websites of medical associations related to pain management.

These websites often have search tools where you can input your location and find specialists nearby who specialise in treating visceral pain.

Last but not least, asking friends, family, and support groups if they have recommendations for pain management doctors who work with visceral pain patients is a great way to find a specialist and team you connect with.  

Persistent Pain Solutions for Visceral Pain in Melbourne

Dr Mittal, a pain specialist in Melbourne, and her collaborative team of healthcare professionals are deeply committed to providing compassionate care to every patient who walks through their doors. 

She understands the physical and emotional challenges of chronic pain and focuses on empathy, understanding, and support in every interaction.

You’ll be met with a compassionate environment where your concerns are heard and your needs are valued. 

Dr Mittal believes that compassion is essential to healing, and she is dedicated to guiding you on your journey to relief from chronic visceral pain and a better, healthier life ahead.