It’s that time of year again. The time when family and friends gather to celebrate the holidays with love, laughter, and good food. Imagine your sitting down to a wonderful holiday dinner with friends. You eat that delicious plate of hot turkey and mashed potatoes and enjoy amazing conversation on a crisp winter evening. When the meal is over, you go about your evening and life is good. Now imagine you eat that same plate of delicious food, and feel it travel through your body as it digests. For those with Visceral Hyperalgesia, life can be pretty painful that way. Visceral Hyperalgesia, also called Visceral Hypersensitivity, is when “an individual has increased sensitivity to pain in the visceral system of internal organs like the stomach, intestines, or pancreas.”1 Typically, the digestive tract allows for stretching and smooth muscle contractions while food is broken down and processed. In the presence of visceral hyperalgesia, the body does not accommodate food and responds as pain instead. It was once described as a ‘sunburn sensitivity’ in the gut…” one that is painful long after the initial cause and remains sensitive for days, or even weeks. Think of visceral hyperalgesia as a pain ‘light-switch’ that gets turned on that cannot be turned off.
The term Visceral refers to the organs of the trunk; such as the stomach, liver, pancreas, and intestines. Hyperalgesia means a heightened sense of pain. Therefore, when you put these two together, Visceral Hyperalgesia means a person feels extreme pain when a stimulus, such as food or drink, is introduced into the stomach or processed in digestion within the intestines and/or bowels. The nervous system overreacts in a sense and treats the stimulus as something problematic. Both involuntary sensory and motor nerves are present throughout visceral organs, but we are unaware of their actions most of the time without any problems.
Let’s break down the nervous system for a moment to better understand. There are two branches to the nervous system: the central nervous system (CNS), consisting of the brain and spinal cord, and the peripheral nervous system (PNS), pertaining to sensory and motor neurons. The PNS has two branches within itself. The sensory-somatic, which is our conscious awareness and voluntary movements, and the autonomic nervous system, pertaining to unconscious body actions such as heart, lung, and other organ functioning. The autonomic nervous system regulates smooth muscles in the organs. The body takes care of things on its own and no one knows the difference.
The stomach and intestines are lined with smooth muscle. These muscles function differently from the skeletal muscles in our arms and legs. Unlike skeletal muscle, which can be moved freely and readily, smooth muscle functions involuntarily. We don’t have to tell ourselves to “break down that ice cream” or to “absorb those nutrients.” Smooth muscles move things throughout the digestive tract unbeknownst to us. Visceral hyperalgesia is what happens when we suddenly feel those smooth muscles doing their job.
Visceral hyperalgesia can be triggered by many things. In some cases, a virus or severe illness can cause temporary damage to the lining of an organ, resulting in pain. The pain then “sensitizes the nerves in the stomach and/or intestines, causing them to be left ‘turn-on’.”
Other gastrointestinal causes are motility problems, such as gastroparesis, organ inflammation, and severe reflux. These triggers may cause pain in only a particular region of the digestive tract, or could affect the entire system. A United States hospital even mentioned that fibromyalgia can affect the organs, triggering heightened visceral pain.
Symptoms can be vague and generalized, making it difficult to explain. Sometimes symptoms are accompanied with bloating, constipation, diarrhea, retching, and vomiting. The reason for this is not know. It could be that visceral hyperalgesia, the painful response to digestion, causes enough anxiety and pain, that the body in turn has trouble functioning the way it should and triggers distress in the form of these symptoms. On the other hand, the presence of such symptoms could be what increases the severity of the visceral hyperalgesia itself. Without a know test to confirm a diagnosis and an origin, it is hard to dicier between the two. Visceral hyperalgesia can also increase pain during infections, viruses, can even elicit a painful response in the smooth muscles from fear and anxiety.
For this reason, visceral hyperalgesia is often diagnosed as a condition of exclusion, meaning all tests for anatomical disorders have come back negative. Doctors frequently perform upper GI series, Endoscopies, Gastric Emptying Scans, and Manometry testing prior to a diagnosis. For some patients, visceral hyperalgesia is a last-resort diagnosis when nothing else fits.
Some specialists will diagnose visceral hyperalgesia as an “underdeveloped nervous system.” This happens more often in neonatal infants and those newborns with neurological impairments. In some cases, doctors believe the children have trouble adjusting to normal stimuli such as sounds, lights, and touch and cry constantly from overstimulation. Doctors term this response “neuro-crying” and believe it may be connected to smooth muscle pain, although no scientific connection has been made at this time.
For children experiencing visceral hyperalgesia, explanations can be difficult. If a child has been experiencing this type of pain their entire life, it becomes a sense of normality. Without knowing any different, their perception of pain is altered and difficult to explain. These children have never experienced what it is like to eat that delicious turkey and be done. They’ve had to learn to make accommodations, and learn to avoid what triggers the pain. Chronic childhood pain presents a whole new side to the prism.
Because diagnosis is so difficult, treatments can be trial and error. During times of post-illness symptoms, short term pain medications work best. Acute pain relievers such as acetaminophen and ibuprofen often relieve symptoms short term. Chronic visceral hyperalgesia is treated differently and from many angles. Commonly used medications include tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Aventyl), and imipramine (Tofranil). Nerve pain medications like gabapentin (Neurontin) also offer relief in some patients with nerve damage. Dicyclomine (Bentyl) can help those patients with intestinal causes. Anti-emetic and nausea medications such as ondansetron (Zofran) can help prevent vomiting, but are meant for short term use.1
It is clear treatment choices are vast, but each case is different, and some unresponsive to medication. For a small group of patients unable to treat the extreme pain through medication or lifestyle adjustments, feeing tubes offer indirect pain relief. Feeding tubes placed surgically into the jejunum (small intestine), called GJ or J tubes, bypass the painfully sensitive area of the digestive tract, allow for nutrients to enter the body pain free. Even this can be a challenge for those with intestinal pain.
Diagnosing visceral hyperalgesia can be a long road. Even with a diagnosis, frequent and recurrent testing may be needed to rule out associated conditions. But for many, a multidimensional approach of medication and lifestyle adjustments offer pain relief. Both acute and chronic visceral hyperalgesia can be manage successfully with the right combination of treatments and therapies. Make sure to speak with your doctor before beginning any visceral hyperalgesia therapy.
Katie is a freelance writer about digestive and nutritional health. She believes accurate and valuable information should be easy to find!