Malignant Visceral Pain

Healthcare providers are familiar with the diffuse and poorly localized quality of visceral pain, as well as its somatic referral patterns from internal organs to dermatomal distributions. Visceral pain also involves significant autonomic and emotional components. When primary or metastatic malignancy is responsible for visceral pain, treating the patient’s pathology and symptomatology becomes more complex. Visceral pain can be initiated by distension of hollow organs, mesenteric traction, ischemia, and inflammatory factors, all of which are associated with solid tumors in the abdomen. Furthermore, common analgesics, such as opioids, can negatively affect visceral function, leading to nausea, vomiting, or constipation, which may negate the drugs’ beneficial effects or even worsen pathology and pain. While clinicians have tools to alleviate visceral pain, none has a perfect efficacy or side effect profile. In metastatic disease, the focus of care should be on improvement of a patient’s quality of life based on his or her personal goals and expectations.