Hepatitis C-What A Pain-Liver Pain!

Liver pain is a common symptom for people living with hepatitis C. Although, we as patients feel somewhat humored when describing the pain to our physicians, we know its there, but do they hear us?

While searching for information related to liver pain and hepatitis C, I found a few interesting facts from an online survey held by Hepatitis C Trust. The survey ran from April 2006 to September 2007 and asked people about their experience during hepatitis C treatment. Also how they felt after treatment ended.

Liver Pain Before, During And After HCV Therapy

Before treatment 33% participants experienced liver pain, that's 165 out of the 500 people who took part in the survey. During therapy 28% of respondents continued to have liver pain. However, six to twelve months after therapy the percentage dropped to 21%. One year after treatment, liver pain was reported by only 15% of people surveyed.

Of the 500 respondents who took part in the survey 90 (18%) reported they had been diagnosed with cirrhosis before starting treatment. To check out the complete survey download the PDF here.

Although HCV infection is not usually a cause of chronic pain, people with hepatitis C can have pain in the liver area as a direct result of the infection. 

According to an article at Better Medicine, the liver’s pain receptors lie primarily on its surface, especially in the capsule covering a portion of the liver, meaning that pressure on the capsule is most often the source of pain. This pain is usually felt in the upper right part of the abdomen, often under the rib cage, and is almost always associated with a swelling or enlargement of the liver, acute inflammation or distention of the liver’s surface, or any other sort of injury that puts pressure on the capsule.

Liver pain may be confused with a more general abdominal pain, unless it occurs specifically in the upper right abdomen. Even then, right upper quadrant pain can be due to gallstones, intestinal pain, pancreatitis, or other abdominal disorders. Because pain in the liver area can be caused by many different conditions, some of which are serious, it is important for you to contact your health care provider to determine the underlying cause.

Additionally, there are diseases that have an association with hepatitis C infection, such as  HCV-associated arthritis or cryoglobinemia, and "Conditions Outside The Liver" which may cause other chronic pain.

A Few Sources Of Pain In Liver Disease

Liver pain. 

Pain in the right upper quadrant of the abdomen, the area over the liver, is due to the distention, or stretching, of the fibrous capsule that encloses the liver. 

Changes in liver size due to inflammation are the most common causes of liver pain.  

If the liver disease progresses towards cirrhosis, the incidence of liver-related right upper quadrant pain tends to decrease.

The Biliary System. 

The gallbladder is a hollow organ located under the lower surface of the liver. 

The liver enfolds the gallbladder and the ducts that transport bile from the gallbladder to the small intestine.

Swelling or inflammation of the liver capsule can cause the gallbladder and bile ducts to become irritated. 

Spasms of the gallbladder and biliary tract can cause pain that radiates to the right shoulder and subscapular area (the area beneath the shoulder blade). 

Inflammation of the gallbladder can also cause pain beneath the lower right margin of the ribcage. 

Intestinal pain.

Intestinal problems can cause extreme pain that can be both acute and chronic. 

Stretching of the large bowel by gas or constipation can cause pain in the upper right quadrant, which can be mistaken for liver pain.

Spasms and cramping can also result from an obstruction, or ileus, of the small bowel. 

Pain in the left upper quadrant can be caused by stretching of the large bowel at the point where it bends sharply down on the way to the sigmoid and rectum (the splenic flexure). 

Pancreatic pain. 

The pancreas is a small, elongated organ that lies just beneath the stomach, mostly on the left side of the body. 

Its job is to secrete insulin and various digestive enzymes.

In viral or alcohol-related hepatitis, the pancreas may become inflamed, causing severe pain that spreads to both upper abdominal quadrants, the back and the shoulder. 

Lying down tends to make the pain worse.  Sitting with the knees to the chest, or bending forward tends to decrease the pain. 

Splenic pain. 

The spleen is a small organ located on the left side of the body, wedged between the stomach, diaphragm and left kidney. 

It is responsible for removing damaged red blood cells from circulation, and controlling the responses of certain cells in the immune system.  

In liver disease, the spleen may become swollen, or may be deprived of blood flow (infarcted).  Pain from the spleen is felt in the right upper quadrantof the abdomen.

Fatty Liver

Most people with simple fatty liver or NASH have no symptoms. However, some people with simple fatty liver or NASH have a nagging persistent pain in the upper right part of the abdomen, over an enlarged liver.

Pain Defined

Somatic pain originates from either the supporting structures or cavities of the body, or from the body surface. 

The somatic nerve pathways report sensations from the abdominal cavity wall, parietal peritoneum (a lining of the abdominal cavity), and parts of the diaphragm. 

The somatic nerves are sensitive to pressure, squeezing, pulling, chemical and bacterial toxins, enzymes, and the accumulation of fluids, like edema.  

Also, the central parts of the diaphragm and biliary tract have nerves that can cause abdominal sensations to be felt in the shoulder - this is called "referred pain."

Somatic pain is sometimes described as sharp, cutting, or stabbing.  It is usually well-localized, meaning the patient can usually point to the source of the pain.

Visceral pain originates in the organs of the body. 

Most solid organs (such as the liver) do not have pain receptors, but are enclosed by a membrane or capsule that generates pain when the organ swells or stretches, exerting pressure on the enclosing membrane. 

Hollow organs, such has the gallbladder, bile tract or intestine, have nerve receptors in the muscular wall of the organ, which can cause pain during stretching or spasm.  

Visceral pain is usually described as deep or dull, and is difficult to localize.  

Neuropathic pain is "nerve pain."  With neuropathic pain, the nerve fibers are damaged or injured, and send incorrect signals to other pain centers.

The nerves send pain messages even though there is no apparent cause for the pain. 

Neuropathic pain may be caused by diseases like diabetes and shingles, or from trauma, surgery, or amputation, or there may be no known cause.

Neuropathic pain may be described as sharp, stinging, like a tooth-ache, or shock-like. It can be very sudden, very intense and very brief, or it may persist.

Of Interest

Functional Dyspepsia; Chronic and persistent upper abdominal pain that's often related to eating