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©2006 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 28, 2006; 12(16): 2477-2486
Published online Apr 28, 2006. doi: 10.3748/wjg.v12.i16.2477
Published online Apr 28, 2006. doi: 10.3748/wjg.v12.i16.2477
Table 1 Multimodal comparison of clinical experimental data obtained in the esophagus from healthy volunteers
Group | Mechanical stimuli | Heat stimuli | Cold stimuli | Electrical stimuli | Sensitization with acid |
Basic data | Differences between the sensations and referred pain areas was evoked by the stimulus modalities[18]. Reliability demonstrated[19,60]. The sensation to mechanical stimulations was unaffected by relaxation of the smooth muscle[40,61]. Evidence for low and high threshold high threshold | Reliability demonstrated. Stimulus-response functions obtained[18,19,60]. | Reliability demonstrated. Stimulus-response functions obtained[18,19,60]. | Reliability demonstrated. Stimulus-response unctions obtained[18,19,60]. | Allodynia and hyperalgesia evoked[19,26], although not consistent for mechanical stimuli (see text)[26,41]. Increased referred pain and amplitude of the nociceptive reflex indicating central hyperexcitability[19,26,46]. Acid perfusion sensitizes the oesophagus to heat but not cold, indicating sensitization of peripheral TRPV1 receptors[28,46]. Remote hyperalgesia was seen in the rectum after acid perfusion of the esophagus[20]. Hyperreactivity of contractions in esophagus, but tone was unaffected[26,46]. |
Gender differences | Males were more sensitive to stimulations, but an increased referred pain area was seen in females, reflecting sex differences incentral pain processing[27,46]. | No differences in sensation, but the referred area was larger in females[27,46]. | As heat stimuli | Males less sensitive to single and repeated stimuli (Staahl et al., unpublished). | In females, the referred pain area increased to heat after acid sensitization, but no changes were seen to mechanical and cold stimulations[46]. |
Pharmacologic modulation | Oxycodone was better than morphine (and placebo) in attenuating mechanical pain[59]. | Oxycodone was better than morphine (and placebo) in attenuating heat pain[59]. | Not done | Both morphine and oxycodone attenuated the electrically evoked pain, but there were no differences between the opioids[59]. | Not done |
Table 2 Multimodal comparison of clinical experimental data obtained in the esophagus from patient with different GI diseases
Patient group | Mechanical stimuli | Heat stimuli | Cold stimuli | Electrical stimuli | Sensitization with acid |
Non-cardiac chest pain[41] | No differences to single stimuli, but increased pain to repeated stimuli and increased referred pain area, reflecting central hyperexcitability. | Not done | Not done | Not done | Increased sensation to mechanical stimulations after acid in patients only. |
Esophagitis[31] | Patients were hyposensitive but with larger and more widespread referred pain. The distension induced more reactive contraction. | Patients were Hypersensitive probably via increased activation of TRPV1 receptors. | No differences | Not done | Not done |
Non-erosive reflux disease (Reddy et al unpublished data) | Patients were hyposensitive to mechanical stimuli. The distensions induced more reactive contractions in the esophagus in the patients and they had larger referred pain areas. Patients with pathological 24-h pH-measurement were more hyposensitive than the patients with normal pH profile. | The patients were hypersensitive to heat with increased referred pain areas to this modality. | No differences between patients and controls | Not done sensitivity score unpublished data) | Patients had a higher sensitivity score to acid perfusion. |
Diabetes (Frøkjær et al, unpublished data) | Patients had hyposensitivity to distension, but increased referred pain areas, reflecting peripheral neuropathy and central hyperexcitability. Increased stiffness of the gut wall in diabetes. | As mechanical stimulations | Not done | As mechanical stimulations | Not done |
Chronic pancreatitis (Dinmcevski et al, unpublished data) | No differences in sensation. No differentiated effect on morphine and oxycodone in attenuation of mechanical pain. | No differences in sensation Oxycodone attenuated heat pain better than morphine. | Not done | Larger referred pain area in the patients. Opioids were not better than placebo in attenuating electrical pain | Not done unpublished data) |
- Citation: Drewes AM, Gregersen H. Multimodal pain stimulation of the gastrointestinal tract. World J Gastroenterol 2006; 12(16): 2477-2486
- URL: https://www.wjgnet.com/1007-9327/full/v12/i16/2477.htm
- DOI: https://dx.doi.org/10.3748/wjg.v12.i16.2477