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Characterizing Abdominal Pain in Patients With Gastroparesis Into Neuropathic and Nociceptive Components

Jehangir, Asad, MD*; Abdallah, Rany T., MD, PhD; Parkman, Henry P., MD*

Journal of Clinical Gastroenterology: July 2019 - Volume 53 - Issue 6 - p 427–433
doi: 10.1097/MCG.0000000000001059
ALIMENTARY TRACT: Original Articles
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Introduction: The cause of abdominal pain (AP) in gastroparesis (Gp) is often not known; hence, its treatment can be challenging. Preoccupation with or increased attention (hypervigilance) to pain is associated with perceived pain severity and psychosocial disability. The aims of this study were to (1) characterize AP in Gp patients into neuropathic and nociceptive pain components; (2) assess these patients for hypervigilance to pain.

Materials and Methods: Gp patients with AP as an important symptom, seen from June 2017 to November 2017 were given validated questionnaires to characterize their AP. Carnett’s sign (worsened AP/tenderness on head/shoulder lift and/or leg lift) was assessed on examination.

Results: Of 32 patients (87% females), 20 had idiopathic Gp, and 9 had diabetic Gp. AP severity using Patient Assessment of Gastrointestinal Symptoms averaged 4.3±0.2 (standard error of mean) for upper AP and 2.3±0.3 for lower AP. AP was typically located in epigastrium (53.1%), and described as sharp (75%). Eleven patients (35.5%) met criteria for neuropathic pain on Neuropathic Pain Questionnaire. Twenty patients (62.5%) had positive Carnett’s sign suggesting somatic pain. Fifteen patients (48.4%) were hypervigilant to pain on Pain Vigilance and Awareness Questionnaire.

Conclusions: Of Gp patients with AP, over one third have a neuropathic component to their pain whereas nearly two thirds have characteristics of somatic pain. Almost half of the Gp patients with AP are hypervigilant to pain. Determining the underlying cause of AP and hypervigilance to pain in Gp patients may assist in devising appropriate treatment strategies.

Departments of *Gastroenterology

Anesthesiology, Temple University Hospital, Philadelphia, PA

A.J. helped in planning the study, collected, and analyzed the data, did literature review, and wrote the manuscript. R.A. helped in planning the study, reviewing the data, and writing the manuscript. H.P.P. was the senior author of the study who planned the study, evaluated the patients included in the study, did literature review, and helped write the manuscript.

The authors declare that they have nothing to disclose.

Address correspondence to: Asad Jehangir, MD, Department of Gastroenterology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140 (e-mail: asadjehangir@gmail.com).

Received February 8, 2018

Accepted April 10, 2018

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