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Co-occurrence of pain syndromes.
Journal of Neural Transmission ( IF 3.3 ) Pub Date : 2019-11-29 , DOI: 10.1007/s00702-019-02107-8
Giannapia Affaitati 1 , Raffaele Costantini 2 , Claudio Tana 3 , Francesco Cipollone 4 , Maria Adele Giamberardino 1
Affiliation  

Many pain conditions in patients tend to co-occur, influencing the clinical expressions of each other in various ways. This paper summarizes the main concurrent pain conditions by analyzing the major interactions observed. In particular, co-occurrence will be examined in: visceral pain (especially ischemic heart disease, irritable bowel syndrome, dysmenorrhea/endometriosis and urinary pain), fibromyalgia, musculoskeletal pain and headache. Two concurrent visceral pains from internal organs sharing at least part of their central sensory projection can give rise to viscero-visceral hyperalgesia, i.e., enhancement of typical pain symptoms from both districts. Visceral pain, headache and musculoskeletal pains (myofascial pain from trigger points, joint pain) can enhance pain and hyperalgesia from fibromyalgia. Myofascial pain from trigger points can perpetuate pain symptoms from visceral pain conditions and trigger migraine attacks when located in the referred pain area from an internal organ or in cervico-facial areas, respectively. The pathophysiology of these pain associations is complex and probably multifactorial; among the possible processes underlying the mutual influence of symptoms recorded in the associations is modulation of central sensitization phenomena by nociceptive inputs from one or the other condition. A strong message in these pain syndrome co-occurrence is that effective treatment of one of the conditions can also improve symptoms from the other, thus suggesting a systematic and thorough evaluation of the pain patient for a global effective management of his/her suffering.

中文翻译:

疼痛综合症并发。

患者的许多疼痛状况倾向于同时发生,以各种方式影响彼此的临床表达。本文通过分析观察到的主要相互作用总结了主要的并发疼痛情况。特别是,将在以下方面检查并发:内脏痛(尤其是缺血性心脏病,肠易激综合症,痛经/子宫内膜异位症和尿痛),纤维肌痛,肌肉骨骼疼痛和头痛。来自内脏的两个并发的内脏疼痛共享至少一部分中央感觉投射,可引起内脏内脏痛觉过敏,即,两个地区的典型疼痛症状均得到改善。内脏疼痛,头痛和肌肉骨骼疼痛(触发点引起的肌筋膜疼痛,关节痛)可加剧纤维肌痛引起的疼痛和痛觉过敏。来自触发点的肌筋膜疼痛可以使内脏疼痛状况的疼痛症状永久化,并且分别位于内脏器官或宫颈面部区域的疼痛区域时,会引发偏头痛发作。这些疼痛关联的病理生理学很复杂,可能是多因素的。在关联中记录的症状相互影响的潜在过程中,一个或另一个条件的伤害性输入会调节中枢敏化现象。这些疼痛综合症并发的一个重要信息是,有效治疗其中一种疾病还可以改善另一种疾病的症状,因此,建议对疼痛患者进行系统而全面的评估,以全面有效地治疗其痛苦。
更新日期:2020-04-19
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