Gastroenterology. 2024 Feb 5:S0016-5085(24)00132-X.doi10.1053/j.gastro.2024.01.045. Online ahead of print.

Alexander C Ford ¹, Stephen Vanner ², Purna C Kashyap ³, Yasmin Nasser ⁴

Author information

¹Leeds Institute of Medical Research at St. James's, University of |Leeds, Leeds, UK; Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

²GI Diseases Research Unit, Kingston General Hospital, Queen's University, Canada.

³Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

⁴Snyder Institute for Chronic Diseases, Cumming School of Medicine, Department of Medicine, University of Calgary, Canada. Electronic address: ynasser@ucalgary.ca.

Abstract

Chronic visceral pain is one of the most common reasons for patients with gastrointestinal disorders, such as inflammatory bowel disease or disorders of brain-gut interaction, to seek medical attention. It represents a substantial burden to patients, and is associated with anxiety, depression, reductions in quality of life, and impaired social functioning, as well as increased direct and indirect healthcare costs to society. Unfortunately, the diagnosis and treatment of chronic visceral pain is difficult, in part because our understanding of the underlying pathophysiologic basis is incomplete. In this review, we highlight recent advances in peripheral pain signaling, and specific physiologic and pathophysiologic pre-clinical mechanisms, which result in the sensitization of peripheral pain pathways. We focus on pre-clinical mechanisms that have been translated into treatment approaches and summarize the current evidence base for directing treatment towards these mechanisms of chronic visceral pain derived from clinical trials. The effective management of chronic visceral pain remains of critical importance for the quality of life of suffers; a deeper understanding of peripheral pain mechanisms is necessary and may provide the basis for novel therapeutic interventions.