They do not have any specialized sense organs and rely on skin receptors to gather sensory information. For example, α-2-receptor agonists may be more efficacious in reversing hyperalgesia when used in combination with ketamine, rather than as a sole agent 68. Therefore, administration of more than one non-opioid adjunct likely has a synergistic effect and may have a greater ability to mollify or prevent OIH. A detailed history and a thorough physical examination should be sufficient to identify the underlying etiology. Special laboratory, diagnostic, and imaging tests may have to be ordered to make a definitive diagnosis of the etiology.

• There have been inspiring reports of certain therapies significantly improving the condition for certain people.
• Visceral hypersensitivity is a complex problem, and treating it requires a holistic approach.
• Microglia A type of immune cell, called a macrophage, that lives in the brain.
• Conversely, individuals with OUD, the uncontrolled use of opioids despite adverse outcomes, may have tolerance and withdrawal symptoms, depending on the presence or lack of opioid use.
• It feels diffused, or not as precisely located as somatic pain from an injury, even when it is intense.

Figure 1. . Clinical differentiation and management of opioid-induced hyperalgesia & opioid tolerance.

Notably, the primary literature highlights that the same pathways involved in OIH are also involved in opioid tolerance, opioid-induced analgesia and chronic pain. Thus, while differentiating these diseases is essential, processes that improve descending modulation or produce analgesia without using opioids are most beneficial, regardless of the diagnosis. Notably, interventions do not need to be pharmacologic, as exercise has been shown to aid in preventing OIH in animals via a descending modulatory-mediated mechanism 33. Alternatively, non-opioid analgesics can assist with opioid dose reduction and may play a role in OIH prevention.

Can diet help with my visceral hypersensitivity symptoms?

The chief symptom of hyperalgesia is increased pain sensitivity (without new injury, damage to an existing injury, or worsening of a medical condition). It is difficult to completely eliminate hyperesthesias and other neuropathic pain symptoms. This should be explained to the patient early during the treatment course. Monotherapy should be initially started; however, 45% of the patients with neuropathic pain are on two or more medications for their pain. Chronic pain also has potential long-term effects that can seriously affect your quality of life.

Visceral hypersensitivity is a complex problem, and treating it requires a holistic approach. Healthcare providers increasingly recognize the importance of the gut-brain connection. Researchers are working to better understand the ways that our brains, organs and nervous systems communicate with each other, and how this might go wrong.

• It is difficult to completely eliminate hyperesthesias and other neuropathic pain symptoms.
• Touch, temperature, pressure and pain will all feel much more intense than expected under ordinary circumstances.
• Both signaling pathways for reducing antinociceptive systems and amplifying pronociceptive signals have been implicated in OIH 28.
• People with VH may also have other symptoms of functional gastrointestinal disorders.
• The contribution of NMDA receptors to OIH and the ability of ketamine to block OIH suggest NMDA antagonism as an important target for OIH prevention 96–98.

Screening, patient education, and medication management choices offer opportunities for prevention. Fibromyalgia is a chronic pain condition that affects millions of people worldwide. While widespread musculoskeletal pain is the hallmark symptom, many individuals with fibromyalgia also experience allodynia and hyperalgesia—two forms of abnormal pain sensitivity. Hyperpathia, hyperalgesia, and allodynia are three manifestations of central sensitization, a condition in which a higher than necessary degree of activity is triggered in the central nervous system. Generally, this activity is triggered by nocioception or the nervous system’s normal response to painful stimuli. People with VH may also have other symptoms of functional gastrointestinal disorders.

Condition Spotlight

Although cyclooxygenase inhibition prevented hyperalgesia in one animal model,76 indomethacin had limited effects in an animal model of OIH 77. Although OIH and opioid tolerance may have similar clinical presentations, they require different management strategies (Figure 1). Tolerance occurs following prolonged opioid administration with pain resulting from reduced efficacy and requires increasing opioid doses. As tolerance is often a magnification of the patient’s baseline pain, increasing the dosage or changing opioids can overcome the effect.

History and Physical

Macrophages that normally live in the skin are called Langerhans cells. And macrophages that normally live in the central nervous system are called microglia. Microglia were originally classified as glial cells, under the assumption that the cells had a merely structural function, before it was realized that the cells were in fact immune cells.

Instead, healthcare providers typically prescribe the same medications they would for psychological mood disorders such as anxiety and depression, only in much lower doses. Any comorbidities, such as mood disorders or sleep disturbances, should be addressed promptly. Patients typically require close follow-up to monitor response to therapy and continued evaluation of the underlying cause. If psychological symptoms are lowering your pain threshold, these medications will help raise that threshold. Treating the pain itself can help reduce stress hormones and put your body and brain in a better place to benefit from mind/body therapies. Our review provides a clinical definition and pathway for differentiation from other diagnoses.

Although several reviews have been written on OIH 17–19, our review will focus on the perioperative patient and include several clinically relevant new studies and guidelines. First, we discuss mechanisms of OIH because they suggest essential areas for targeted treatment (section 1). Next, we summarize the recent controversy in the diagnosis of OIH, and provide a proposed compromised definition and path to differential diagnosis (section 2). In particular, our review provides an expanded focus on steps in the perioperative setting in which preventative steps can be taken to prevent OIH (section 3).

How does visceral sensitivity contribute to functional gastrointestinal disorders such as IBS?

In other words, with hyperalgesia, there is increased pain response to a painful stimulus. A neurologist (a physician who specializes in disorders of your brain, spinal cord and peripheral nerves) should be able to localize the area of dysfunction and perform tests to find the root of the problem. They may get blood work, electrophysiologic studies (electromyography EMG and nerve conduction studies), neuroimaging studies (magnetic resonance imaging MRI), neuromuscular ultrasound and more. The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Hyperesthesia

Your provider’s job is to diagnose and treat conditions you have; they won’t judge what you’re experiencing or how it’s affecting your life. The goal of diagnosis and treatment is to help return your senses to how they should be working and keep them from drowning out the things you want to experience. These nerves send pain signals to the part of your brain that registers pain, which signals to your brain regions that process the emotional part of the pain. An emotional response is part of your hyperalgesia: causes, symptoms, treatment, and more body’s way of teaching you to avoid whatever injured you.