1. Abdominal pain can originate from somatic, visceral, or parietal structures. Visceral pain originates from internal organs and is transmitted through the autonomic nervous system. 2. Visceral pain signals travel to the dorsal horn of the spinal cord and converge with somatic pain signals. This combined signal is interpreted by the brain as coming from the somatic structure. 3. Referred pain occurs when damage to deep tissues causes pain to be perceived from a distant site, misleading the actual location of the damage.

1. PAIN in relation to
Abdomen
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Solivar, Cathy
Presented By

2. Somatic Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Pathway

3. Visceral Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Pain Categories
Chronic Pain (days or week)
Knawing, burning or cramping
Affects Hollow organs
Biliary Tree
Intestines
Affects Solid Organs
Liver -capsule
Radiates to the midline
Difficult to localize

4. Visceral Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Pathway
Second-order projections form ascending
bundles to brainstem and diencephalon
structures, including the thalamus,
hypothalamus, periaqueductal gray, and
reticular formation.
Third-order neurons in the thalamus send
projections to the somatosensory cortex
for pain perception.
Visceral pain is primarily mediated by
sympathetic pathways, although the
parasympathetic system plays a role in
pain signaling in the distal GI tract,
especially in the distal colon and rectum.
Originates from noxious stimuli within
internal organs and is transmitted
through the autonomic nervous system.
Detected by afferent A-δ and
unmyelinated C fibers in the connective
tissue of visceral organs.
They synapse onto the dorsal horn of the
spinal cord, with cell bodies located in
the dorsal root ganglion.
The dorsal horn serves as a critical
junction where afferent pain signals.

5. Visceral Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Pathway

6. Visceral Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Convergence Projection Theory
Convergence-projection theory: Visceral afferent
fibers converge with somatic afferent fibers on the
same neural bodies in the dorsal horn →
The signal is sent through the spinal cord to the
thalamus and the somatosensory cortex
Brain's Interpretation:
When these combined signals reach the brain, it interprets
the pain as coming from the somatic structure that
corresponds to the somatic fibers that converged with the
visceral fibers

7. Visceral Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Convergence Projection Theory
Nociceptors Activation in the Pancreas:
Nociceptors in the pancreas detect this pain and send pain
signals to the central nervous system.
Travel of Visceral Pain Signals:
The pain signals from the inflamed pancreas travel to the
dorsal horn of the spinal cord.
Convergence of Pain Signals:
In the spinal cord, these pain signals from the pancreas
converge with somatic pain signals from the lower back.
The somatic pain signals in the lower back could be due to
various reasons, such as muscle strain or injury.
Shared Pathways:
These combined signals travel up the spinal cord and reach
the brain as a single signal.
Brain's Interpretation:
The brain interprets this combined signal as pain coming
from the lower back, which corresponds to the somatic
structure converging with the visceral pain signals from
the pancreas.
Pancreatic Pain (Visceral Pain):
1.
2.
3.
4.
5.

8. Reffered Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Pain Categories
When the damage to deep
tissues is severe or long lasting,
the sensation it produces may
be misperceived as arising from
a site that is distant from the
actual site of damage

9. Parietal Pain
ABDOMINAL PAIN
COURSE: GASTROINTESTINAL
Pain Categories
Originates from
inflammation
Parietal peritoneum
More Severe
Located more easily
Aggravated by
Coughing
Relieved by position
Anatomy affected in
Parietal Pain
Abdominal Muscle
Parietal Peritoneum
Sensory Nerves
Phrenic Nerves
Lower Intercostal
Nerves
Subcostal Nerves