http://www.painonline.org/peri.htmPeristalic or Visceral PainCentral Pain In The Hollow Organs The gut does not burn, not even protopathic burning, and there is some debate about whether to consider nausea or cramping as the gut's counterpart of burning. Consequently the question of whether Central Pain creates gut dysesthesia remains unanswered. However, such abdominal pains as are present are clearly hyperpathic, for example the full bladder burns intensely in Central Pain and the bowels may feel as if they are going to explode. Following Bowsher's criteria, dysesthesia includes burning. However, this definition was created for simplicity of diagnosis so non-pain specialists would recognize Central Pain. The definition was intended to be pared to the bone and was not all inclusive. Since digestive viscera do not burn in Central Pain but do manifest fullness, cramping, and nausea, the increase in the same may be hyperpathic, or it may likely be the only way the gut can display dysesthesia. As in other parts of the body and in the bladder, inappropriate abdominal pain probably reflects both dysesthetic and hyperpathic components. The autonomic nervous system, which is poorly understood, conveys pain from hollow organs. A definition of Central Pain based on the nociceptive process in the skin may not have a good fit for describing Central Pain in the gut. We need further knowledge to speak confidently in this area. Central Pain patients do have increased complaint of "acid stomach" but considering their intense suffering, it is not determined whether this is a hyperpathic response to esophageal reflux, or is in fact, a type of dysesthesia.. The gut then, does not burn, but that is practically the only pain the bladder can produce. In the bladder, which does burn, it is very tempting to term the sensation as dysesthetic. Here again, one must be careful, since the burning in the bladder might simply be hyperpathic. However, there are enough Central Pain patients who term the bladder burning "creepy" to suspect it is dysesthetic, at least so far as that term applies to autonomic pain. Bladder Central Pain feels like a dysesthetic urinary tract infection, with considerable discomfort. The patient has a startling urge to void, which is unpredictable and not unlike a spastic bladder. The patient generally must carry a receptacle for immediate voiding to relieve the pain. Pain during orgasm has also been reported, but pain from touch on skin surfaces is the major problem during physical relations. In the gut the sensation of pain as urge to defecate is located in the rectum, and is precipitated by the presence of stool or flatus. The Central Pain patient must remain close to a toilet because the sudden urge to defecate can be tremendous. The problem is exacerbated due to sensory loss at the rectum. This prevents awareness that stool is present. Soilage from soft stools can be one more discouraging aspect of Central Pain. Although pain receives most of the attention, sensory loss certainly contributes to the clinical picture. The problem again is that because the doctor encounters complaint of pain from touch in a given area, he is often unaware that touch is impaired in the patient. Von Frey hairs can demonstrate the loss, but are seldom used in this hurried-up age of "managed care". Sensory Dysuria and Sensory Fecal Incontinence Soilage is an occasional problem for the same reason as above. This is sensory incontinence; inadequate sensory input to alert the patient to the presence of stool at the rectal sphincter. This is a definite problem socially and prevents mobility for the patient. Visceral hyperpathia is also present in both the digestive and tracts, which means that when the bladder becomes full or when stool is ready to be expelled, the patient is unaware of this at the normal threshold of sensation, but becomes aware late and the sensation is powerful, in a sort of crisis.When the signal does appear, the signal has "delay with overshoot". It is wildly overblown, and it is also dysesthetic (the bladder burns unbearably) creating an irresistible urge to urinate, or as the case may be, to defecate. This is in addition to the fact that because of the subtle sensory loss, the patient is missing the alerting message in people without Central Pain that the bladder is about to be full or that the sigmoid is nearly full of stool. Many embarrassing social moments will afflict these patients. It prevents going to meetings or buildings where sudden resort to the restroom in unavailable. This also restricts car travel.Patients deal with the problem by paying very close attention to sensation from the bladder and rectum, by fasting prior to trips or before going out, and by staying home except for important events. Occasional failures are nevertheless inevitable, particularly if the stool becomes soft, providing little or no warning of its presence in the rectum. Diarrhea is certain to cause embarrassment. Amitryptiline is popular among Central Pain patients, not only because it makes dysesthetic burning on the skin more bearable, but also because it lessens the hyperpathic pain of bladder distention.