Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork , Cork , Ireland.
Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork , Cork , Ireland ; Department of Anatomy and Neuroscience, University College Cork , Cork , Ireland.
Front Psychiatry. 2015 Feb 16;6:15. doi: 10.3389/fpsyt.2015.00015. eCollection 2015.
Visceral pain is a global term used to describe pain originating from the internal organs, which is distinct from somatic pain. It is a hallmark of functional gastrointestinal disorders such as irritable-bowel syndrome (IBS). Currently, the treatment strategies targeting visceral pain are unsatisfactory, with development of novel therapeutics hindered by a lack of detailed knowledge of the underlying mechanisms. Stress has long been implicated in the pathophysiology of visceral pain in both preclinical and clinical studies. Here, we discuss the complex etiology of visceral pain reviewing our current understanding in the context of the role of stress, gender, gut microbiota alterations, and immune functioning. Furthermore, we review the role of glutamate, GABA, and epigenetic mechanisms as possible therapeutic strategies for the treatment of visceral pain for which there is an unmet medical need. Moreover, we discuss the most widely described rodent models used to model visceral pain in the preclinical setting. The theory behind, and application of, animal models is key for both the understanding of underlying mechanisms and design of future therapeutic interventions. Taken together, it is apparent that stress-induced visceral pain and its psychiatric comorbidities, as typified by IBS, has a multifaceted etiology. Moreover, treatment strategies still lag far behind when compared to other pain modalities. The development of novel, effective, and specific therapeutics for the treatment of visceral pain has never been more pertinent.
内脏痛是一个通用术语，用于描述源自内部器官的疼痛，与躯体痛不同。它是功能性胃肠疾病（如肠易激综合征）的标志。目前，针对内脏痛的治疗策略并不令人满意，由于缺乏对潜在机制的详细了解，新型治疗方法的发展受到阻碍。在临床前和临床研究中，压力一直被认为与内脏痛的病理生理学有关。在这里，我们讨论了内脏痛的复杂病因，同时回顾了我们目前在压力、性别、肠道微生物群改变和免疫功能作用方面的理解。此外，我们还回顾了谷氨酸、GABA 和表观遗传机制作为治疗内脏痛的可能治疗策略的作用，这种疼痛存在未满足的医疗需求。此外，我们还讨论了在临床前环境中用于模拟内脏痛的最广泛描述的啮齿动物模型。动物模型背后的理论及其应用对于理解潜在机制和设计未来的治疗干预措施至关重要。综上所述，很明显，由肠易激综合征等典型疾病引起的应激性内脏痛及其精神共病具有多因素病因。此外，与其他疼痛模式相比，治疗策略仍然远远落后。因此，开发针对内脏痛的新型、有效和特异性治疗方法从未如此重要。
