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Chronic visceral pain secondary to ventral disc herniation: Development of visceral complex regional pain syndrome.

Lauretti GR, de Oliveira R - Saudi J Anaesth (2015 Jul-Sep)

Bottom Line: When an organ disease is ruled out as the origin of pelvic pain, the superior hypogastric plexus (SHP) injury and consequent dysfunction could be the mechanism of visceral chronic pain perpetuation.As much as a dorsal discus herniation may harm the dorsal or ventral roots, a ventral discus herniation at L4-L5 or L5-S1 may result in direct physical trauma to the SHP, maintaining chronic visceral pain mediated by sympathetic dysfunction, conceivably also afferent fibers dysfunction.We propose that similarly to nociceptive somatic dysfunction named complex regional pain syndrome, the maintained sympathetic pelvic pain secondary to straight physical damage to the SHP characterize in fact the same disease, but in nociceptive visceral tissue, named visceral complex regional pain syndrome, a concept constructed based on the International Association for the Study of Pain criteria (1994).

View Article: PubMed Central - PubMed

Affiliation: Department of Biomechanics Medicine and Rehabilitation of Locomotor Members, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

ABSTRACT
When an organ disease is ruled out as the origin of pelvic pain, the superior hypogastric plexus (SHP) injury and consequent dysfunction could be the mechanism of visceral chronic pain perpetuation. As much as a dorsal discus herniation may harm the dorsal or ventral roots, a ventral discus herniation at L4-L5 or L5-S1 may result in direct physical trauma to the SHP, maintaining chronic visceral pain mediated by sympathetic dysfunction, conceivably also afferent fibers dysfunction. We propose that similarly to nociceptive somatic dysfunction named complex regional pain syndrome, the maintained sympathetic pelvic pain secondary to straight physical damage to the SHP characterize in fact the same disease, but in nociceptive visceral tissue, named visceral complex regional pain syndrome, a concept constructed based on the International Association for the Study of Pain criteria (1994).

No MeSH data available.


Related in: MedlinePlus

Lateral vision of ventral discus extrusion deriving from lumbar L4-L5, accommodating over the ventral face of the L5 lumbar disc, where superior hypogastric plexus lyes
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Figure 2: Lateral vision of ventral discus extrusion deriving from lumbar L4-L5, accommodating over the ventral face of the L5 lumbar disc, where superior hypogastric plexus lyes

Mentions: Patient 1-Male, history of disturbing pelvic pain associated to upper right abdominal pain. Thoracic and lumbo-sacral magnetic resonance revealed ventral discus herniation at thoracic T11-T12 and lumbar L4-L5 levels. Patient was submitted to L3, L4, and L5 sympathetic test block [Figure 1], which evidenced a ventral discus extrusion deriving from L4 to L5, accommodating over the ventral face of the L5 lumbar disc [Figure 2]. Patient had relief from pelvic pain after sympathetic test block combined to SHP test block, and from upper abdominal right pain from right splanchnic test block at T11 and T12. After 5 months, as pain gradually returned, he was submitted to radiofrequency ablation.


Chronic visceral pain secondary to ventral disc herniation: Development of visceral complex regional pain syndrome.

Lauretti GR, de Oliveira R - Saudi J Anaesth (2015 Jul-Sep)

Lateral vision of ventral discus extrusion deriving from lumbar L4-L5, accommodating over the ventral face of the L5 lumbar disc, where superior hypogastric plexus lyes
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4478827&req=5

Figure 2: Lateral vision of ventral discus extrusion deriving from lumbar L4-L5, accommodating over the ventral face of the L5 lumbar disc, where superior hypogastric plexus lyes
Mentions: Patient 1-Male, history of disturbing pelvic pain associated to upper right abdominal pain. Thoracic and lumbo-sacral magnetic resonance revealed ventral discus herniation at thoracic T11-T12 and lumbar L4-L5 levels. Patient was submitted to L3, L4, and L5 sympathetic test block [Figure 1], which evidenced a ventral discus extrusion deriving from L4 to L5, accommodating over the ventral face of the L5 lumbar disc [Figure 2]. Patient had relief from pelvic pain after sympathetic test block combined to SHP test block, and from upper abdominal right pain from right splanchnic test block at T11 and T12. After 5 months, as pain gradually returned, he was submitted to radiofrequency ablation.

Bottom Line: When an organ disease is ruled out as the origin of pelvic pain, the superior hypogastric plexus (SHP) injury and consequent dysfunction could be the mechanism of visceral chronic pain perpetuation.As much as a dorsal discus herniation may harm the dorsal or ventral roots, a ventral discus herniation at L4-L5 or L5-S1 may result in direct physical trauma to the SHP, maintaining chronic visceral pain mediated by sympathetic dysfunction, conceivably also afferent fibers dysfunction.We propose that similarly to nociceptive somatic dysfunction named complex regional pain syndrome, the maintained sympathetic pelvic pain secondary to straight physical damage to the SHP characterize in fact the same disease, but in nociceptive visceral tissue, named visceral complex regional pain syndrome, a concept constructed based on the International Association for the Study of Pain criteria (1994).

View Article: PubMed Central - PubMed

Affiliation: Department of Biomechanics Medicine and Rehabilitation of Locomotor Members, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

ABSTRACT
When an organ disease is ruled out as the origin of pelvic pain, the superior hypogastric plexus (SHP) injury and consequent dysfunction could be the mechanism of visceral chronic pain perpetuation. As much as a dorsal discus herniation may harm the dorsal or ventral roots, a ventral discus herniation at L4-L5 or L5-S1 may result in direct physical trauma to the SHP, maintaining chronic visceral pain mediated by sympathetic dysfunction, conceivably also afferent fibers dysfunction. We propose that similarly to nociceptive somatic dysfunction named complex regional pain syndrome, the maintained sympathetic pelvic pain secondary to straight physical damage to the SHP characterize in fact the same disease, but in nociceptive visceral tissue, named visceral complex regional pain syndrome, a concept constructed based on the International Association for the Study of Pain criteria (1994).

No MeSH data available.


Related in: MedlinePlus