Pain Types and Viscerogenic Pain Patterns

Question 1

Anything impinging the central diaphragm…

Answer 1

refer pain to the shoulder

Question 2

Anything impinging peripheral diaphragm…

Answer 2

refer pain to ipsilateral costal margins

Question 3

Phrenic nerve innervates digaphragm, pericardium, gallbladder, pancreas refers pain to..

Answer 3

somatic area of C3-C5 (shoulder)

Question 4

Vascular Pain Descriptors

Answer 4

throbbing, pounding, pulsing, beating

Question 5

Neurogenic Pain Descriptors

Answer 5

sharp, crushing, pinching, burning, hot, searing, stinging, itchy, pulling, jumping, shooting, electrical, gnawing, pricking

Question 6

Musculoskeletal Pain Descriptors

Answer 6

aching, sore, heavy, hurting, deep, cramping, dull

Question 7

Emotional Pain Descriptors

Answer 7

tiring, miserable, vicious, agonizing, nauseating, frightful, piercing, dreadful, punishing, exhausting, killing, bearable, annoying, cruel, sickening, torturing

Question 8

Embryonic Development

Answer 8

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

Question 9

Multisegmental Innervention

Answer 9

Viscera often have multisegmental innervations. There is overlapping spinal afferent neurons. So cardiac pain is not felt in heart but referred to area supplied by corresponding spinal nerves.

Question 10

Direct Pressure and Shared Pathways

Answer 10

Occurs as a result of ganglions from each neural system gathering and sharing information through the cord to the plexus. Not only is it true that any structure that touches the diaphragm can refer pain to the shoulder, but also neighboring structures to the diaphragm can refer to shoulder as well.

Question 11

For peds: pain or hurt

Answer 11

Use the word hurt

Question 12

Progressive pattern with cyclical onset

Answer 12

systemic disease

Question 13

Symptoms that occur alone or in conjunction with the pain of systemic disease

Answer 13

Associated Symptoms

Question 14

Systemic Pain Descriptors

Answer 14

• recent sudden, with no onset
• generally constant pain, night pain, unrelieved by change in position, migratory arthralgias
• cannot alter, alleviate, eliminate pain
• may be organ dependent with corresponding relieving factors

Question 15

Systemic Pain S/S

Answer 15

• fever
• sweats
• unusual vitals
• cancer warning signs
• GI symptoms
• bilateral symptoms
• painless weakness of muscles
• dyspnea
• diaphoresis
• visual disturbance
• skin lesions
• bowel and bladder symptoms

Question 16

Aggravating Systemic Factors

Answer 16

• esophagus-eating or swallowing aggravates it
• heart - cold, exertion, stress, heavy meal affects it
• GI - peristalsis affected

Question 17

Relieving Factors

Answer 17

• gallbladder - leaning forward
• kidney - leaning toward affected side
• pancreas - sitting upright or leaning forward may reduce symptoms

Question 18

Superficial somatic structures

Answer 18

skin, superficial fasciae, tendon sheaths, periosteum

Question 19

Deep somatic structures

Answer 19

periosteum, spongy bone, nerves, muscles, tendons, ligaments, blood vessels

Question 20

Origins of Visceral Pain

Answer 20

• innervation is multisegmental
• few nerve receptors in structures
• pain felt with stretching or pressure

Question 21

Heart Innervation

Answer 21

C3-C4

experience pain in jaw, neck, shoulder, mid-back, arm, chest

Question 22

Heart and Lung Innervation

Answer 22

T1-T4

Question 23

Gallbladder, Bile Ducts, stomach Innervation

Answer 23

T7-T8

Question 24

Gallbladder, Diaphragm Innervation

Answer 24

C3-C5

Question 25

Duodenum Innervation

Answer 25

T9-T10

Question 26

Appendix Innervation

Answer 26

T10

Question 27

Renal/Ureter Innervation

Answer 27

L1-L2

Question 28

Viscero-Viscero reflex

Answer 28

occurs when pain or dysfunction in one organ causes symptoms in another organ

Question 29

Somato-Visceral reflex

Answer 29

biomechanical dysfunction causes visceral changes

Question 30

Visceral-somatic reflex

Answer 30

internal organ impairment may cause referred pain

Question 31

Neuropathic Pain

Answer 31

• results from damage to neurons
• sharp, shooting, burning, tingling
• not aided by opiates or narcotics

Question 32

Appears as dull deep ache that responds to rest or NWB position which increases after movement

Answer 32

deep somatic pain

Question 33

Dull ache not feeling better after rest or recumbency

Answer 33

visceral pain

Question 34

Trigger Points

Answer 34

hyperirritable spots within a taut band of skeletal muscle or in the fascia