Summary And Conclusions

The inability to treat pain adequately, particularly persistent pain, continues to be a major problem in health care. The dearth of effective therapeutic interventions with minimal side effects is due to a number of factors related to the complexity of nociceptive signaling. These include the fact that pain is a submodality within the larger somatosensory system, that the response to injury is dynamic, that the type of injury impacts the response and consequently the underlying mechanisms of pain, that history of the organism impacts the response to subsequent injury, that demographic factors such as age and sex impact the response to injury, and that the site of injury impacts the response and consequently underlying mechanisms of pain. As indicated in chapters throughout the rest of this volume, all of these factors are particularly relevant to visceral pain. Despite the complexity of nociceptive processing and a therapeutic armament that has not kept pace with advances in our understanding of this complexity, there is still reason for optimism that effective therapeutic interventions are not far off. There are two main reasons for this optimism, particularly with respect to the prospects for novel treatments for visceral pain. The first is that preclinical results with novel interventions have been promising (169,170). The second is that several exciting targets have been identified that appear to function at points of convergence of discrete cellular pathways.

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