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 The Mnemonic of Central Pain
Peristalic or Visceral Pain
Central Pain In The Hollow Organs
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The gut does not burn, not even protopathic burning, and there is some
debate about whether to consider nausea or cramping as the gut's counterpart of burning.
Consequently the question of whether Central Pain creates gut dysesthesia remains
unanswered. However, such abdominal pains as are present are clearly hyperpathic, for
example the full bladder burns intensely in Central Pain and the bowels may feel as if
they are going to explode. Following Bowsher's criteria, dysesthesia includes burning.
However, this definition was created for simplicity of diagnosis so non-pain specialists
would recognize Central Pain. The definition was intended to be pared to the bone and was
not all inclusive. Since digestive viscera do not burn in Central Pain but do manifest
fullness, cramping, and nausea, the increase in the same may be hyperpathic, or it may
likely be the only way the gut can display dysesthesia. As in other parts of the body and
in the bladder, inappropriate abdominal pain probably reflects both dysesthetic and
hyperpathic components. The autonomic nervous system, which is poorly understood, conveys
pain from hollow organs. A definition of Central Pain based on the nociceptive process in
the skin may not have a good fit for describing Central Pain in the gut. We need further
knowledge to speak confidently in this area. Central Pain patients do have
increased complaint of "acid stomach" but considering their intense suffering,
it is not determined whether this is a hyperpathic response to esophageal reflux, or is in
fact, a type of dysesthesia.. The gut then, does not burn, but that is practically the
only pain the bladder can produce. In the bladder, which does burn, it is very tempting to
term the sensation as dysesthetic. Here again, one must be careful, since the burning in
the bladder might simply be hyperpathic. However, there are enough Central Pain patients
who term the bladder burning "creepy" to suspect it is dysesthetic, at least so
far as that term applies to autonomic pain. Bladder Central Pain feels like a dysesthetic
urinary tract infection, with considerable discomfort. The patient has a startling urge to
void, which is unpredictable and not unlike a spastic bladder. The patient generally must
carry a receptacle for immediate voiding to relieve the pain. Pain during orgasm has also
been reported, but pain from touch on skin surfaces is the major problem during physical
relations.
In the gut the sensation of pain as urge to defecate is located in the rectum, and is
precipitated by the presence of stool or flatus. The Central Pain patient must remain
close to a toilet because the sudden urge to defecate can be tremendous. The problem is
exacerbated due to sensory loss at the rectum. This prevents awareness that stool is
present. Soilage from soft stools can be one more discouraging aspect of Central Pain.
Although pain receives most of the attention, sensory loss certainly contributes to the
clinical picture. The problem again is that because the doctor encounters complaint of
pain from touch in a given area, he is often unaware that touch is impaired in the
patient. Von Frey hairs can demonstrate the loss, but are seldom used in this hurried-up
age of "managed care".
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Sensory Dysuria and Sensory Fecal Incontinence
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Soilage is an occasional problem for the same reason as above. This is
sensory incontinence; inadequate sensory input to alert the patient to the presence
of stool at the rectal sphincter. This is a definite problem socially and prevents
mobility for the patient. Visceral hyperpathia is also present in both the digestive
and tracts, which means that when the bladder becomes full or when stool is ready to be
expelled, the patient is unaware of this at the normal threshold of sensation, but becomes
aware late and the sensation is powerful, in a sort of crisis.
When the signal does appear, the signal has "delay with overshoot". It is
wildly overblown, and it is also dysesthetic (the bladder burns unbearably) creating an
irresistible urge to urinate, or as the case may be, to defecate. This is in addition to
the fact that because of the subtle sensory loss, the patient is missing the alerting
message in people without Central Pain that the bladder is about to be full or that the
sigmoid is nearly full of stool. Many embarrassing social moments will afflict these
patients. It prevents going to meetings or buildings where sudden resort to the restroom
in unavailable. This also restricts car travel.
Patients deal with the problem by paying very close attention to sensation from the
bladder and rectum, by fasting prior to trips or before going out, and by staying home
except for important events. Occasional failures are nevertheless inevitable, particularly
if the stool becomes soft, providing little or no warning of its presence in the rectum.
Diarrhea is certain to cause embarrassment.
Amitryptiline is popular among Central Pain patients, not only because it makes
dysesthetic burning on the skin more bearable, but also because it lessens the hyperpathic
pain of bladder distention.
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Disclaimer:
All material on PainOnline is strictly the opinion of the
authors of the material on this Web site. PainOnline does not attempt to
offer medical advice. If you have concerns about your health, please see a
qualified health care provider.Copyright © 2001 by David Berg
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