Visceral pain: the ins and outs, the ups and downs

Even with specialist-level palliativPurpose of review Visceral pain represents a major clinical problem, yet far less is known about its mechanisms compared with somatic pains, for example, from cutaneous and muscular structures. Recent findings In this review, we describe the neuroanatomical bases of visceral pain signalling in the peripheral and central nervous system, comparing to somatic pains and also the channels and receptors involved in these events. We include an overview of potential new targets in the context of mechanisms of visceral pain and hypersensitivity. Summary This review should inform on the recognition of what occurs in patients with visceral pain, why comorbidities are common and how analgesic treatments work. Keywords descending modulation, visceral hyperalgesia, visceral pain, viscerosomatic convergencee care, cancer pain can be difficult to treat especially when the pain is complicated by profound suffering. It is paramount to consider not only the patients’ biochemical factors but also their psychosocial and spiritual/existential influences. A multidimensional approach with knowledge of the risk factors for poor pain control is important to prevent, detect, and manage risk factors for intractable pain, including psychosocial distress, addictive behavior, and delirium in patients with terminal cancer. We present 3 cases of patients with advanced cancer with intractable bone pain whose hospital courses were complicated by severe psychosocial distress and delirium. We also propose an algorithm of multidimensional approach to unrelieved pain and suffering in patients with advanced cancer. Keywords advanced cancer, cancer pain, psychosocial distress, chemical coping, delirium, multidimensional approach