The World Congress on Pain has closed its 14th Conference on August 31st in Milan, with over 7,800 registered delegates from more than 110 countries attending the biggest event ever. Newly elected president of the International Association for the Study of Pain (IASP), Dr. Fernando Cervero of Montréal, Canada, announced that the Global Year Against Visceral Pain will launch on October 22, 2012, bringing global attention to an area of pain that affects almost everyone during some part of their lives. A multidisciplinary task force of researchers and clinicians has been established to raise awareness about visceral pain and to foster advancements in research and clinical practice among the scientific community.  

Visceral pain is second only to trauma as the reason that patients visit emergency rooms in hospital. Women report it three times more often than men. More studies are needed to learn about how stress affects visceral pain, the pharmacological process and the effect of environment and genetics.

Visceral pain encompasses many specialties, including cardiology, pulmonology, gastroenterology, urology, gynecology, obstetrics, and internal medicine. Visceral pain is diffuse and often poorly localizable. “There is an innate fear of visceral pain,” states Dr. Fred Howard, New York, gynecologist. People are far more distressed by visceral pain than pain from a source they can readily see. “Visceral pain is an exquisitely common human experience. Sixty to 80% of patients are motivated to enter the health care system because of pain, and visceral pain is the largest part of that – all of our internal organs – if they don’t work quite right, pain is almost always a result,” declares Dr. Timothy Ness, Birmingham, USA, anesthesiologist. “Visceral pain is second only to trauma as the reason that patients visit the emergency room in hospitals,” Dr. Qasim Aziz, London, professor of Neurogastroenterology, adds.

New directions of research are aimed at understanding the causes of visceral pain, through biomarkers and brain imaging techniques. “It is interesting to see how brain imaging processes are modified by stress, and to see what is happening in the pathways from the gut to the brain. Recent work suggests there is a difference between males and females in their response to pain. We see the emotional areas of the brain more activated in females than males, but more studies are needed to find the causes for the pain they experience. Future research will also focus on the pharmacological process and looking at the behavior of neurotransmitters in the brain,” Dr. Qasim Aziz, London, professor of Neurogastroenterology, explains.

Emotional aspects are crucial to the perception of pain and new directions of research are investigating emotional interference and interventions. “Brain imaging helped to depict the role of the amygdala, anterior cingulate cortex, and insula during the visceral pain perception,” Dr. Shin Fukudo, Sendai, Japan, a gastroenterologist in Psychosomatic Medicine, explains. “The dorsolateral prefrontal cortex (DLPFC) is one of the key regions to control visceral pain and negative emotion.  Evidences show beneficial effects of repetitive transcranial magnetic stimulation on the DLPFC to suppress anxiety induced by visceral pain”.  

 “Visceral pain seldom comes alone,” Dr. Ursula Wesselmann, Birmingham, USA, an anesthesiologist, comments. The phenomenon of pain comorbidities and the complications that arise when patients have more than one illness or pain simultaneously, is the topic of one of the newest books by IASP. Pain Comorbidities: Understanding and Treatment of the Complex Patient, edited by Drs. Maria Adele Giamberardino of Chieti, Italy and Troels S. Jensen of Aarhus, Denmark, brings together 41 of the foremost medical authorities in the world to explore the nature, diagnoses, and treatment of complex clinical situations involving multiple concurrent diseases and their influence on the experience of pain.

Sponsored by the International Association for the Study of Pain (IASP), the Global Year is a 12-month campaign focused on education about a specific area of pain for health care professionals, government leaders, and the public. Fact sheets about many aspects of visceral pain, including chronic chest pain, chronic pelvic pain, functional abdominal pain, bladder pain, and bowel pain are prepared by a multidisciplinary task force of researchers and clinicians and will be available on the IASP website in a variety of languages beginning the 3rd Monday of October, 2012.