|Feb 12, 2009|
mom to 4 kids with probable
Dealing with Fundo, J tube feedings,Severe Dysmotility,Aspiration,Asthma,
Connective Tissue Disorder,
Visceral Hyperalgesia, and more
I am familiar with abdominal migraines because I have read about it a lot, and there are right many kids on another board I post on that have it.
Brent is not diagnosed with abdominal migraines, he is diagnosed with visceral hyperalgesia,a pain disorder, in his case resulting from his motility disorder,nerve damage,etc. Elavil,Lyrica,Neurontin, can all be used as treatment. He takes high dose Neurontin daily, a chronic pain medicine to treat neuropathic(nerve related) pain, it also can be used to treat migraines and seizures. Neurontin has helped him a lot,he also takes zofran(odansetron) daily.
Visceral Hyperalgesia, which may also be called Visceral Hypersensitivity, is a term that simply means an individual has increased sensitivity to pain in the visceral system of internal organs like the stomach, intestines, or pancreas. Normally, when one eats or drinks, the stomach and intestines stretch to accommodate the meal with no discomfort whatsoever. But in a child with Visceral Hyperalgesia, the mere act of filling the stomach or intestine with a small amount of fluid or food triggers the nerves in the gut to respond as if a painful stimulus has been introduced.
If motor nerves are affected, a motility disorder develops, and when sensory nerves are affected, Visceral Hyperalgesia is often the result. It is common for both types of disorders to be present in tandem.
What is painless to most children feels excruciatingly painful to children with Visceral Hyperalgesia. Children with this diagnosis commonly have pain responses to one or more types of agents: pain due to digestive processes such as food entering the gut or liquid stretching the gut; significantly increased pain due to infections, viruses, or other external insults on the gut; and a pain response to psychological events such as anxiety or fear. In many children, all that is needed to cause pain is the introduction of food into the stomach and intestine. Once the pain signal has been turned on, the pain may persist for weeks, months, or years, or may come in intermittent cycles.
What causes Visceral Hyperalgesia? In many cases, it occurs after a virus, illness, or other external assault on the gut. The illness causes temporary damage to the mucus lining of the stomach and intestines, resulting in stomach pain. This pain then sensitizes the nerves in the stomach and/or intestines, causing them to be left "turned on" and hypersensitive to pain. Other gastrointestinal conditions such as pancreatitis, motility disorders, cyclic vomiting ,abdominal migraine, or even severe reflux may also trigger Visceral Hyperalgesia. In some children, only one small area of the digestive tract is affected, while in others, most or all of the gut is impacted.
Symptoms of Visceral Hyperalgesia are vague and often very difficult to categorize. All diagnosed children experience pain, but the pain may be localized, diffuse, sharp, dull, burning, intermittent, or constant. Many children with severe Visceral Hyperalgesia also have other symptoms such as bloating, constipation, diarrhea, retching, or vomiting. This is especially the case when both the sensory and motor nerves of the gut are affected. In many children, pain triggers gastrointestinal symptoms like retching and vomiting, which in turn create even more pain and distress. These additional symptoms, coupled with pain, may be so severe that a feeding tube or even a central line must be placed for enteral or intravenous feedings.
Many children with Visceral Hyperalgesia, especially post-infectious hypersensitivity, will recover in time with no treatment. Other children, especially those with underlying gut issues like pancreatitis or a motility disorder, may require substantial intervention to provide adequate nutrition and manage pain and additional gastrointestinal symptoms.
Children with acute-onset Visceral Hyperalgesia may benefit from typical acute pain medications ranging from Motrin to Morphine. In general, children who need acute pain relief are given non-narcotic pain relievers such as Tylenol or Motrin, or pseudo-opiates like Tramadol, since narcotics and opiates disturb motility of the gut and may worsen gut function in the long run. Once Visceral Hyperalgesia has become more habitual, other pain medications may be more appropriate. Commonly used medications include tricyclic antidepressants, especially Amitriptyline (Elavil), Nortriptyline (Pamelor), and Imipramine (Tofranil). Medications to treat neuropathic pain have also proven helpful, especially Gabapentin (Neurontin) and its new cousin Pregabalin (Lyrica). Other possible medications include Nifedipine (Procardia); Dicyclomine (Bentyl), Alosetron (Lotronex) or Tegaserod (Zelnorm) for children with more intestinal issues; Ondansetron (Zofran) to prevent vomiting; Hyoscyamine (Levsin) for children with spasms; and other anticholinergic and anti-nausea medications. Older children, particularly those with concurrent psychological disorders, may benefit from behavioral therapy or consultation with a chronic pain psychologist. Some children may also improve by receiving continuous small feeds through a feeding tube, particularly feedings directly into the jejunum via a GJ or J tube. Children with extremely severe Visceral Hyperalgesia may need a central line and TPN (IV) feedings to allow total gut rest.
Brent took periactin as an infant, and it didnt help him at all(he took it for appetite stimulant), but I know of many others whom it has helped a lot