Week 4- Pain Type and Viscerogenic Pain Patterns

Question 1

PART 1

Answer 1

PART 1

Question 2

Are there nerve fibers or nociceptors in organs?

Answer 2

No, suspected that pain transmission from organs is a result of peripheral mechanisms.

Question 3

Why are we not able to specifically locate where pain stems from when it reaches the brain?

Answer 3

Signals project to SEVERAL AREAS OF THE BRAIN, therefore the cortex cannot distinguish where pain messages originate.

Question 4

What are (3) mechanisms to consider in regards to referred visceral pain?

Answer 4

• Embryonic Development
• Multisegmental Innervation
• Direct pressure and shared pathways

Question 5

(SQ)

Describe Embryologic Development mechanism for referred visceral pain. What are some examples?

Answer 5

-Pain is referred to a site where the organ was located in fetal development.

Examples

• Chest is part of gut in embryo. Thoracic disorders can refer to abdomen.
• Heart starts as cranial structure in embryo. MI or pericarditis can refer to abdomen.
• Kidney and ear come from same embryonic tissue. Kidney dysfunction can refer to ear pain.

Question 6

(SQ)

Describe Multi-segmental Innervation mechanism for referred visceral pain. What are some examples?

Answer 6

-Organs have multiple levels of innervation. Overlapping or same segmental projections can refer to different areas.

Examples
-Cardiac pain is not felt in the heart but referred to areas of corresponding spinal nerve. Can occur in any structure innervated by T3-T4 (jaw, neck, upper trap, shoulder, arm).

Question 7

(SQ)

Describe Direct Pressure and Shared Pathways mechanism for referred visceral pain. What are some examples?

Answer 7

-Organ that is inflammed/problematic and is causing organ to be larger than normal. Irritates structures and can refer pain to areas also innervated structure being irritated.

Examples

• Spleen → L shoulder
• Tail of pancreas → L shoulder
• Head of pancreas → R shoulder
• Gallbladder → R shoulder
• Liver → R shoulder

Question 8

Direct Pressure and Shared Pathways:

• Impingement on central diaphragm can refer to __________.
• Impingement on peripheral diaphragm can refer to ___________ and/or ____________

Answer 8

• central diaphragm = shoulder

- peripheral diaphragm = costal margins (ipsilateral) and/or lumbar region

Question 9

PART 2: SOURCES OF PAIN

Answer 9

PART 2: SOURCES OF PAIN

Question 10

What are the possible sources of pain? (6)

Answer 10

• Cutaneous
• Somatic
• Visceral
• Neuropathic
• Referred
• Central Sensitization (CS)

Question 11

(SQ)
Cutaneous Sources of Pain:
-Includes superficial somatic structures in _____ and _____________.
-Pain is well ________ (can point to area that “hurts”).
-Can be associated with referred pain from _______ or ______ _______ structures.
-Is cutaneous pain a reliable indiicator of pathologic etiology?

Answer 11

• skin and subcutaneous tissue
• well localized
• viscera or deep somatic structures
• No

Question 12

(SQ)

What are the (5) types of Somatic Sources of Pain?

Answer 12

• Superficial Somatic
• Deep Somatic
• Somatovisceral
• Viscerosomatic
• Somatoemotional (psychosomatic)

Question 13

Somatic Sources of Pain:

• ____________ pain is a result of conditions including skin, superficial fascia, tendon sheaths, and periosteum.
• ____________ pain is a result of pathological conditions of periosteum or cancellous bone, nerves, muscles, tendons, ligaments, blood vessels, deep fascia, and joint capsules.
• Which is POORLY LOCALIZED and may refer to body surface (cutaneous pain)?

Answer 13

• Superficial somatic pain
• Deep somatic pain
• Deep somatic pain