Referred Pain and Pain patterns Flashcards
1
Q
What is referred pain
A
dysfunction in one area that leads to pain somewhere else
2
Q
What are mechanisms of referred pain
A
- related to development
- multisegmental innervation
- direct pressure/shared pathway
3
Q
How is development related to referred pain?
A
- CT and organs come from the same cell resulting in shared characteristics
- for example the kidney and ear came from the same area in embryo
- and referred pain tends to stay on the same side that they organ is on
4
Q
Mulisegmental innervation
A
- organs are innervated via the autonomic nervous system
- input is sent back to the rest of the system over several spinal segments
- result is diffuse pain, or pain in a location distant from the source
- the innervation spans many levels of the spinal cord and can be innervated by a similar part as another area
5
Q
Direct pressure as a mechanism of referred pain
A
- pressure on the respiratory diaphragm by an organ can refer pain
- pressure/impingement on the central portion of diaphragm: shoulder pain (closer to the top of abdomen)
- pressure on the peripheral portion of diaphragm: lumbar or rib pain
6
Q
Shared pathways as a mechanism
A
- spinal nerves innervate across many levels and can also innervate many things
- C3-C5 innervate phrenic nerve/diaphragm but also pericardium, pancrease, gallbladder
- can cause pain in shoulder/thoracic spine
7
Q
How do you figure out if they are symptoms of MSK pain vs other pain
A
- history: if they dont remember a mechanism of injury
- location: typically referred pain pattern
- fluctuation: MSK pain tends to hurt when you use it vs a constant pain that does get better/worse with movement
- type of pain: acute vs chronic; stapping, throbbing sharp etc
- night pain for months at a time
8
Q
Night pain
A
- may be a red flag
- cancer
- ischemic heart disease due to the pressure on the chest from laying down
- peptic ulcer disease
- or DJD of spine, pelvis, or hips
- always ask more questions
9
Q
- back pain and what to look for
A
- deep or constant: refer back + pair with history
- bowel or bladder changes
- pain with weight-bearing could be a fracture may need to refer back
- pain with activity but not MSK
10
Q
Thoracic pain
A
- patient may or may not say back pain
- could be cardiac, pulmonary, GI, or gallbladder
11
Q
Shoulder or neck pain
A
- deep or constant pain
- cardiac: pain will increase with activity ie: shoulder pain from walking down the stairs
- cervical injuries
- neuropathies/nerve compression
- tumor; pancoast tumor (lung cancer)
12
Q
Jaw pain causes
A
- TMJ
- cardiac: cardiac ischemia can cause jaw pain that is not pain with activity
13
Q
Headaches severe cases
A
- infection
- tumor
- bleed
- refer back if treatments are not working or if they say its the worst headache they have ever had
14
Q
Elbow, wrist, hand pain
A
- fracture
- ligament
- infection
- raynaud syndrome can go up
- complex regional pain syndrome:
15
Q
Knee pain
A
- can be referred from the hip or groin
- assess the knee
