Functional chest pain: nociception and visceral hyperalgesia

Area of Science:

• Gastroenterology
• Neuroscience
• Pain Medicine

Background:

• Functional chest pain is a prevalent yet poorly understood clinical condition.
• Historically attributed to psychologic factors or motility disorders, recent research highlights visceral hyperalgesia.
• The precise role of the gut-brain axis, whether central or peripheral, in visceral hypersensitivity remains under investigation.

Purpose of the Study:

• To review evolving research and clinical strategies for functional chest pain.
• To emphasize the role of esophageal sensory (afferent) neuronal dysfunction.
• To discuss diagnostic approaches and therapeutic interventions.

Main Methods:

• Review of current literature on functional chest pain.
• Discussion of diagnostic modalities including high-dose proton pump inhibitors (PPIs), upper endoscopy, esophageal pH monitoring, and esophageal balloon distension.
• Exploration of emerging diagnostic techniques like functional MRI, magnetoencephalography, and cortical evoked potentials.

Main Results:

• Visceral hyperalgesia is increasingly recognized as a key factor in functional chest pain.
• Gastroesophageal reflux disease (GERD) can be identified as a pain source through empirical therapy and diagnostic tests.
• Esophageal balloon distension is a valuable tool for diagnosing hypersensitivity.

Conclusions:

• Esophageal sensory dysfunction and visceral hyperalgesia are central to understanding functional chest pain.
• A combination of diagnostic methods is often necessary to identify underlying causes.
• Current therapeutic mainstays include high-dose PPIs and low-dose tricyclic antidepressants or trazodone, with emerging treatments showing promise.