Pain + Visceral Referral Patterns

Question 1

What are some differences between A-Delta and C fibers?

Answer 1

A-Delta transmit information FAST from peripheral structures

C-Fibers transmit information from deeper structures (joints, viscera) slower

Question 2

What type of fibers provide input to inhibitory interneurons and are the basiss of e-stim and massage with regards to the gate control theory?

Answer 2

A-Alpha and A-Beta fibers

so trying to activate these to inhibit A-delta and C-fibers

Question 3

What is another word for endorphins?

Answer 3

Opiopeptins

Question 4

How long is the line for Visual Analog Scale?

Answer 4

10-15cm

Question 5

Where is the spleen located and where does it refer?

Answer 5

Spleen is located in the left upper quadrant.

Pain in left upper quadrant and refers to left shoulder

Question 6

Where does the diaphragm refer?

Answer 6

Stimulation of the peripheral portions of the diaphragm result in sharp pain the costal margins and sometimes lumbar region.

Stimulation of the central portion results in sharp pain tin the upper traps and shoudlers on ipsilateral side of stimulation

Question 7

Where does the lower urinary tract refer?

1. Bladder/urethra
2. Prostate

Answer 7

Bladder/Urethra: Pain in suprapubic regions or diffuse lower back pain.
Prostate: Pain in the low back, pelvis, sacrum, perineum, inner thighs, testes

Question 8

Where does the large intestine refer?

Answer 8

Lower abdomen and to the sacrum with passing of gas or defecation

Question 9

Where does the heart refer?

How may women present differently?

Answer 9

Pain in the substernal regrion, midthoracic, bilateral jaw, left upper trap, left shoulder, and down medial aspect of the left arm to the 5th digit

Women can present with uncharateristic like symptoms including epigastric pain, right shoulder pain, and feelings of indigestion

Question 10

Where does the kidney refer?

Answer 10

Suprailiac and posterior lower back on ipsilateral side.

Question 11

Where does pleura refer to?

Answer 11

over the lung area

Question 12

Where does an aortic aneursym refer to?

Answer 12

Over the aorta in the front and back in the thoracic and lumbar areas.

So it would be like midscapular for thoracic and in lower abdominals for abdominal aortic aneurysm

Question 13

Where does the liver, gallbladder and bilary refer to?

Answer 13

Right upper quadrant and posterior right upper back (around scapula)

Question 14

Where does the espophagus and stomach refer to?

Answer 14

Mid upper quadrant and interscapular

Right Posterior Shoulder

Question 15

Where does the instestines refer?

Answer 15

lower quadrant and low back

Question 16

Where can pancreas refer to?

Answer 16

mid upper quadrant and mid back at thoracolumbar junciton

Left shoulder

Question 17

Where is the liver, gallbladder, and bilary ducts located?

Answer 17

Right upper quadrant

Question 18

Where is the pancreas?

Answer 18

under the liver, more midline

Question 19

What shoulder do the stomach, liver/gallbladder, renal, heart, spleen, central diaphragm, and pancreas refer to?

Answer 19

Pancreas: left shoulder. OPPOSITE LIVER
Stomach: posterior right shoulder
Liver: right shoulder
Renal: ipsilateral shoulder
Heart: Left shoulder (sometimes R in women)
Spleen: left shoulder (spleen located in LUQ)
Central diaphragm: ipsilateral shoulders

Question 20

What is a common pain questionnaire?

Answer 20

McGill Pain Questionnaire

Question 21

What is the difference between hyperalgesia and allodynia?

Answer 21

Allodynia refers to the sensation of pain in response to a stimulus that would not typically produce pain.

This is not to be confused with hyperalgesia, which is an increased sensitivity to pain caused by a noxious stimulus.