90. What causes pain in mast cell disease?
- Most mast cell patients experience some kind of pain. Because mast cells are involved in pain sensation and inflammation, mast cell patients are at risk of pain by different mechanisms throughout their body.
- Mast cells are involved in nerve pain. Mast cells often live very close to nerves, sometimes so close they are touching. When nerve cells feel pain, they release mediators to activate mast cells. The mast cells then activate other nearby nerve cells. The result of this is that the brain gets a pain signal from lots of nerves, not just the nerves that initially felt the pain, so the pain you feel is worse.
- Mast cells participate in inflammation. One of the big things they do is send signals to other immune cells to come to the site of inflammation. These cells release mediators that can cause pain or make it worse. Nerve cells nearby will send a stronger pain signal again in response to these immune cells causing inflammation.
- Mast cells are involved in hyperalgesia, when your nerves are very sensitive and send a stronger than normal pain response to things that shouldn’t normally be very painful. For this reason, many mast cell patients have a heightened pain response, even to things that aren’t normally very painful.
- Mast cells are associated with a number of chronic pain conditions.
- Visceral pain is when you feel pain in your internal organs, like your GI tract or your liver. Visceral pain is often not localized so it can be hard to tell what is actually hurting. Mast cell patients often report visceral pain.
- Pelvic pain is linked to mast cell activation and can cause serious symptoms, including painful sex. Pelvic floor dysfunction is sometimes seen in mast cell patients. Interstitial cystitis, chronic inflammation of the bladder, is also driven by mast cells, although it’s not exactly clear how.
- Mast cells are major players in GI pain. Mast cell degranulation activates the nerves inside the GI tract, which can cause abdominal pain. This causes pain in a number of GI diseases aside from mast cell disease.
- Many mast cell patients have connective tissue disease like Ehlers Danlos Syndrome. This can cause the organs to not be supported properly, causing them to move around, activating a pain response.
- Mast cells can cause bone pain in multiple ways. In systemic mastocytosis, production of so many mast cells in the bone marrow can cause pressure inside the bone that causes pain. Mast cell mediators can cause dysregulation of the system that degrades old parts of the bone and replaces it with new, stronger bone. This can cause the bones to be too thick or too thin. Mast cell patients may have bone disorders as a result and should be especially watchful for Mast cell mediators like histamine can also irritate the cells on the outside of the bone, causing pain.
- Mast cell activation can cause headaches and migraines. Mast cell mediators can affect how much blood is getting to the head and brain, which can cause pain. Many mast cell patients have POTS, which can also cause the same problem.
- Systemic mastocytosis patients can have dense infiltration of their organs by mast cells. This infiltration punches holes in the tissue, leading to inflammation and pain.
- Cutaneous mastocytosis patients have similar issues with infiltration of the skin.
- Infiltration is NOT necessary for mast cell activation to cause pain.
- Mast cell patients have to be cautious in how they treat their pain as many medications for pain management can cause mast cell degranulation.
- NSAIDs can be used in patients that tolerate them.
- Acetaminophen and tramadol are considered mast cell friendly.
- Gabapentin and pregabalin are sometimes used for neurologic pain in mast cell patients.
- If opiates are needed, fentanyl and hydromorphone are preferred. Morphine is a massive mast cell degranulator and should be avoided.
- Certain numbing medications can trigger mast cells, like ester caine anesthetics.
- Cyclobenzamide is a muscle relaxer commonly used in mast cell patients.
For more information, please visit the following posts:
The Provider Primer Series: Medications that impact mast cell degranulation and anaphylaxis
Premedication and surgical concerns in mast cell patients
The Sex Series – Part Six: Male pelvic floor and mast cells
The Sex Series – Part Eight: Female pelvic floor dysfunction
The Sex Series – Part Nine: Female pelvic floor dysfunction