The swinging pendulum of oesophageal pain—Away from the centre back towards the periphery again

The swinging pendulum of oesophageal pain—Away from the centre back towards the periphery again 1IntroductionArguably one of the great continuing controversies in visceral pain research is whether the pathology that leads to chronic symptoms is largely concentrated in the periphery or in central structures. In this issue of the Scandinavian Journal of Pain, Frøkjær and coworkers [1] report their findings of a case-control study where they sought to delineate the presence or absence of microstructural changes in the central pain neuromatrix of patients with functional chest pain of presumed oesophageal origin (FCP). Using diffusion tensor imaging, they demonstrated that, in a well-defined cohort of functional chest pain patients in the absence of psychological comorbidity, that there were no differences in white matter microstructure. This suggests that the pathophysiology of FCP, in a select group of patients, lies outside these structures. FCP is characterized by recurrent unexplained midline chest pain. The Rome III diagnostic criteria include at least 3 months of symptoms, with onset at least 6 months prior to diagnosis, in the absence of another cause such as oesophageal dysmotility or gastro-oesophageal reflux disease [2]. Despite this criteria, it remains unclear as to whether disorders with similar symptoms, albeit with contrasting nomenclature such as non-cardiac chest pain (NCCP) or syndrome X, represent identical http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

The swinging pendulum of oesophageal pain—Away from the centre back towards the periphery again

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Publisher
De Gruyter
Copyright
© 2014 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2014.01.006
Publisher site
See Article on Publisher Site

Abstract

1IntroductionArguably one of the great continuing controversies in visceral pain research is whether the pathology that leads to chronic symptoms is largely concentrated in the periphery or in central structures. In this issue of the Scandinavian Journal of Pain, Frøkjær and coworkers [1] report their findings of a case-control study where they sought to delineate the presence or absence of microstructural changes in the central pain neuromatrix of patients with functional chest pain of presumed oesophageal origin (FCP). Using diffusion tensor imaging, they demonstrated that, in a well-defined cohort of functional chest pain patients in the absence of psychological comorbidity, that there were no differences in white matter microstructure. This suggests that the pathophysiology of FCP, in a select group of patients, lies outside these structures. FCP is characterized by recurrent unexplained midline chest pain. The Rome III diagnostic criteria include at least 3 months of symptoms, with onset at least 6 months prior to diagnosis, in the absence of another cause such as oesophageal dysmotility or gastro-oesophageal reflux disease [2]. Despite this criteria, it remains unclear as to whether disorders with similar symptoms, albeit with contrasting nomenclature such as non-cardiac chest pain (NCCP) or syndrome X, represent identical

Journal

Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

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