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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of epidural and intrathecal opiates in obstetrics is reviewed. Opiate receptors in the substantia gelatinosa of the spinal cord appear to be the main site of drug action after both epidural and intrathecal modes of drug administration. However, an additional systemic effect for this selective spinal analgesia cannot be excluded, especially after epidural drug administration. Contrary to that of general surgery patients, the response of pregnant women at term to epidural opiates is unpredictable. The action of the opiates is of short duration. There are at least three anatomical reasons for this phenomenon: an extensive epidural venous blood flow during pregnancy, visceral fibers (uterine contraction pain) located deeper in the substantia gelatinosa than somatic fibers (skin and peritoneal pain), and A delta fibers (uterine pain) which bypass opiate receptors in the substantia gelatinosa. After intrathecal injection of opiates, there was a strong analgesic action during delivery, but an unacceptable amount of side effects prevents their routine use. In post-cesarean patients, epidurally administered opiates are quite effective analgesics, but they still have one serious unwanted effect: respiratory depression of delayed onset. Thus, in routine obstetric practice, epidural or intrathecal opiates play only a limited role.
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PMID:Epidural and intrathecal opiates in obstetrics. 614 72

The parietal peritoneum (PP) is innervated by somatic and visceral afferent nerves. PP receives sensitive branches from the lower intercostal nerves and from the upper lumbar nerves. Microscopically, a dense network of unmyelinated and myelinated nerve fibers can be found all over the PP. The unmyelinated fibers are thin and are ending just underneath the PP. The myelinated fibers can penetrate the PP to reach the peritoneal cavity, where they lose their myelin sheath and are exposed to somatic and nociceptive stimuli. PP is sensitive to pain, pressure, touch, friction, cutting and temperature. Noxious stimuli are perceived as a localized, sharp pain. The visceral peritoneum (VP) itself is not innervated, but the sub-mesothelial tissue is innervated by the autonomous nerve system. In contrast to the PP, the visceral submesothelium also receives fibers from the vagal nerve, in addition to the spinal nerves. VP responds primarily to traction and pressure; not to cutting, burning or electrostimulation. Painful stimuli of the VP are poorly localized and dull. Pain in a foregut structure (stomach, duodenum or biliary tract) is referred to the epigastric region, pain in a midgut structure (appendix, jejunum, or ileum) to the periumbilical area and pain from a hindgut source (distal colon or rectum) is referred to the lower abdomen or suprapubic region. Peritoneal adhesions can contain nerve endings. Neurotransmitters are acetylcholine, VIP, serotonin, NO, encephalins, CGRP and substance P. Chronic peritoneal pain can be exacerbated by neurogenic inflammation, e.g. by endometriosis.
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PMID:Peritoneal innervation: embryology and functional anatomy. 3091 46

Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic, translational, and clinical investigations. The collaborative effort among the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, American Pain Society, and American Academy of Pain Medicine Pain Taxonomy (AAAPT) provides a systematic framework to classify acute painful conditions. Using this framework, a multidisciplinary working group reviewed the literature and developed core diagnostic criteria for acute abdominal and peritoneal pain after surgery. In this report, we apply the proposed AAAPT framework to 4 prototypical surgical procedures resulting in abdominal and peritoneal pain as examples: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection. These diagnostic criteria address the 3 most common surgical procedures performed in the United States, capture diverse surgical approaches, and may also be applied to other surgical procedures resulting in abdominal and peritoneal pain. Additional investigation regarding the validity and reliability of this framework will facilitate its adoption in research that advances our comprehension of mechanisms, deliver better treatments, and help prevent the transition of acute to chronic pain after surgery in the abdominal and peritoneal region. PERSPECTIVE: Using AAAPT, we present key diagnostic criteria for acute abdominal and peritoneal pain after surgery. We provide a systematic classification using 5 dimensions for abdominal and peritoneal pain that occurs after surgery, in addition to 4 specific surgical procedures: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection.
J Pain
PMID:AAAPT Diagnostic Criteria for Acute Abdominal and Peritoneal Pain After Surgery. 3200 1