pain types and patterns Flashcards
Describe cutaneous pain
- skin
- localized (like one finger)
- associated with referred or deep somatic pain
What are the 4 sources of pain?
- Cutaneous
- Deep somatic
- Visceral
- Referred
describe deep somatic pain
- bone, nerve, muscle, tendon, ligament, arteries, joints, spongy or cancellous bone, periosteum
- poorly localized
- often referred
describe visceral pain
- internal organs, heart
- poorly localized because of multi segmental innervation (cardiac pain: C3-T4)
- few nerve endings
- associated with ANS response
Is the visceral pleura sensitive or insensitive to pain?
it is insensitive to pain
What does pain correspond to?
the dermatomes from which the organ receives its innervations
Describe referred pain
- cutaneous, soma, viscera
- pain felt in an area far from the site of the lesion
- but supplied by the same or adjacent neural segments
- includes all structures: cutaneous, deep somatic and visceral
is referred pain localized or not?
- it is localized
- can spread or radiate from point of origin
- can occur alone but usually preceded by visceral pain when an organ is involved
What are mechanisms of referred pain?
- embryologic development
- multisegmental innervation
- direct pressure and shared pathways
If the right ear is missing on a fetus what would you also check and why?
the right kidney because they are shared by the same gene (embryologic development mechanism of referred visceral pain)
Describe multisegment innervation
- visceral pain is referred to the corresponding somatic area
- all organs are innervated by the ANS
Describe direct pressure and shared pathways for referred visceral pain
-pain or cardiac and diaphragmatic origin is often felt in the shoulder because the heart and the diaphragm are supplied by the C5-6 spinal segment
If the site of lesion is diaphragmatic irritation where would be the referral site?
- shoulder,
- low back
if the site of lesion is heart where is the referral site?
- shoulder,
- neck,
- upper back,
- TMJ
if the site of lesion is the urogenital tract where would be the referral site?
- back,
- inguinal region and
- genitalia
if the site of lesion is pancreas, liver, spleen, gallbladder where would be the referral site?
- shoulder
- midthoracic or
- low back
If there is a somatic lesion in C7, T1-5 where would the referral site be?
- Interscapular
- posterior shoulder
If there is a somatic lesion in the shoulder where would the referral site be?
- neck
- upper back
If there is a somatic lesion in L1-2 where would the referral site be?
- SI joint
- hip
If there is a somatic lesion in hip joint where would the referral site be?
- SI joint
- knee
If there is a somatic lesion in pharynx where would the referral site be?
-ipsilateral ear
If there is a somatic lesion in TMJ where would the referral site be?
- head
- neck
- heart
What are the characteristics of pain?
- location/onset
- description
- intensity
- duration
- frequency
What patterns do you look for in visceral pain?
- gradual, progressive, cyclical
- constant
- intense
- unrelieved by rest or change of position
- does not fit the expected mechanical or neuromusculoskeletal pattern
