Guest Editorial 7 important coexistence must be carefully discussed with patients and other healthcare professionals. Otherwise, patients will be stigmatized as having pain that is psychological in origin, their complaints and distress will not be taken seriously and pharmaceutical companies will not invest in drug development for visceral pain. Patients with visceral pain need careful assessment and it is entirely correct that they are referred to specialists for investigation and treatment in the first instance. But, often, organic pathology is ruled out and patients are discharged from the acute specialty with the reassurance that no obvious reason for their pain can be found, or they are given treatments in the expectation that the pain will resolve, but it persists. Patients become anxious and concerned that their persistent symptoms indicate that investigations have not been extensive enough, that more tests are needed and that pathology and the reason for their pain has been missed. This situation is made worse if questions are then asked for the first time about previous psychiatric history and present mood and any positive therapeutic relationship can be lost.

Historically, patients with somatic pain formed the largest percentage of patients referred to pain management services. However, I suggest that this will change in the future. The pressure on acute hospital trusts to reduce emergency department attendances, to reduce the number of acute admissions and especially readmissions, will mean that all hospitals need to identify better ways to manage the large number of patients referred with visceral pain. This is where pain management services can assist their trust, by developing unique expertise in these complex problems. Pain management services should ask themselves if they currently have the knowledge and the training to do this. The International Association for the Study of Pain (IASP) has identified visceral pain as the theme for the Global Year against Pain from October 2012 to October 2013. There are many factsheets on the IASP website that can be downloaded free, as can the organisation’s newsletter, Pain: Clinical Updates. We should ask the following questions. Are we confident in performing vaginal and rectal examinations and, if not, how should we learn? Who should deliver the training?