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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1. Referred pain of visceral origin has three major characteristics: visceral pain is referred to somatic areas that are innervated from the same spinal segments as the diseased organ; visceral pain is referred to proximal body regions and not to distal body areas; and visceral pain is felt as deep pain and not as cutaneous pain. The neurophysiological basis for these phenomena is poorly understood. The purpose of this study was to examine the organization of viscerosomatic response characteristics of spinothalamic tract (STT) neurons in the rostral spinal cord. Interactions were determined among the following: 1) segmental location, 2) effects of input by cardiopulmonary sympathetic, greater splanchnic, lumbar sympathetic, and urinary bladder afferent fibers, 3) location of excitatory somatic field, e.g., hand, forearm, proximal arm, or chest, 4) magnitude of response to hair, skin, and deep mechanoreceptor afferent input, and 5) regional specificity of thalamic projection sites. 2. A total of 89 STT neurons in segments C3-T6 were characterized for responses to visceral and somatic stimuli. Neurons were activated antidromically from the contralateral ventroposterolateral oralis or caudalis nuclei of the thalamus. Cell responses to visceral and somatic stimuli were not different on the basis of the thalamic site of antidromic activation. Recording sites for 61 neurons were located histologically; 87% of lesion sites were located in laminae IV-VII or X. There was no relationship between response properties of the neurons and spinal laminar location. 3. Different responses to visceral stimuli were observed in three zones of the rostral spinal cord: C3-C6, C7-C8, and T1-T6. In C3-C6, urinary bladder distension (UBD) and electrical stimulation of greater splanchnic and lumbar sympathetic afferent fibers inhibited STT cells. Electrical stimulation of cardiopulmonary sympathetic afferents increased cell activity in C5 and C6 and either excited or inhibited STT cells in C3 and C4. In the cervical enlargement (C7-C8), STT cells generally were either inhibited or showed little response to stimulation of visceral afferent fibers. In T1-T6, input from greater splanchnic and cardiopulmonary sympathetic afferent nerves increased activity of STT cells. Lumbar sympathetic afferent input inhibited cells in T1-T2 and had little effect on cells in T3-T6, whereas UBD decreased cell activity in all segments studied. 4. In general, stimulation of somatic structures increased activity of STT neurons in segments that received primary afferent innervation from the excitatory somatic receptive field or in the segments immediately adjacent to these segments. Only input from the forelimb, especially the hand, markedly excited cells in C7 and C8.+
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PMID:Segmental organization of visceral and somatic input onto C3-T6 spinothalamic tract cells of the monkey. 147 31

Referred pain in the midface and teeth is a common clinical feature of the cluster headache and cluster headache-like disorders. It is not unusual therefore for patients with cluster headaches to go to the dentist. In this report, 33 cases of cluster headache, which met the International Headache Society classification criteria, and which were seen by us during a 2-year period, are reviewed. Fourteen (42%) of 33 patients who were seen by dental practitioners and who received some form of ineffective dental or pharmacologic treatment are described here. Since almost 50% of the cluster headache patients described here received inappropriate dental treatment, it is hoped that this review and retrospective assessment will make the dental practitioner aware of this disorder and provide a broader perspective in the treatment of pain in the orofacial region. Clinical presentation, pathogenesis, and treatment of cluster headaches are discussed.
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PMID:A retrospective study of patients with cluster headaches. 151 33

Referred pain is common in the orofacial region and can cause considerable difficulties in diagnosis. Referred pain is defined as pain that is referred to a part of the body other than the site of origin, and as a result, severe pain may arise without an associated causative lesion. A muscular trigger point that resembled a tooth with endodontic involvement is discussed.
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PMID:Referred pain of muscular origin resembling endodontic involvement. Case report. 200 17

Referred pain in the leg is occasionally due to a pelvic soft tissue tumour. Among 11 patients who presented this way, one had a lymphoma, one had a benign schwannoma, and nine had soft tissue sarcomas. Most patients had undergone a variety of procedures, including laminectomy, before the correct diagnosis was established. In five cases, an accurate diagnosis was obtained by needle biopsy. The lymphoma responded to chemotherapy, and the benign schwannoma was excised. Of the nine patients with soft tissue sarcoma, six underwent marginal/intracapsular excision, three receiving supplementary radiotherapy, and two were treated by nonsurgical means. Hindquarter amputation was technically impossible or inappropriate in these cases. All those with high-grade tumours have died or have metastases. Of four patients with low-grade tumours, three have exhibited only slow disease progression. Careful judgment and a precise histopathological diagnosis are required in planning treatment for patients with pelvic soft tissue tumours causing referred pain in the leg.
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PMID:Primary soft tissue tumours of the pelvis causing referred pain in the leg. 202 16

In three patients pain in the groin and thigh which was initially attributed to either a malfunctioning hip prosthesis or osteoarthritic hip, was shown to arise in the spine. All patients had positive myelograms and one had electromyographic evidence of nerve root compression. Referred pain from the spine must always be considered in the differential diagnosis of pain thought to be arising from a hip replacement.
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PMID:Spinal lesions simulating hip joint disorders. 226 45

Musculoskeletal pain of the posterior thoracic area has many etiologies. Referred pain from the abdominal organs is noted for the right sided viscera, the stomach, and the pancreas. Kidney pathology, however, is not listed among the differential diagnoses. A case of a renal calculus causing posterior thoracic wall pain is presented with an examination of the relevant pain pathways.
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PMID:A new differential diagnosis for musculoskeletal posterior thoracic wall pain. A case report. 252 30

Four studies are presented testing the validity and reliability of pressure pain thresholds (PPTs) and of examination parameters believed to be important in the clinical assessment of sites commonly used for such measures in patient samples. Forty-five patients with a myogenous temporomandibular disorder were examined clinically prior to PPT measures. Criteria for history and examination included functional aspects of the pain, tissue quality of the pain site, and the type of pain elicited from palpation. Control sites within the same muscle and in the contralateral muscle were also examined. PPTs were measured as an index of tenderness using a strain gauge algometer at these sites. The data from the 5 male subjects were excluded from subsequent analyses due to the higher PPT in the males and to their unequal distribution among the various factorial conditions. The first study demonstrated strong validity in PPT measures between patients (using pain sites replicating the patients' pain) and matched controls (n = 11). The PPT was not significantly different between the primary pain site (referred pain and non-referred pain collapsed) and the no-pain control site in the same muscle (n = 16). The PPT was significantly lower at the pain site compared to the no-pain control site in the contralateral muscle (n = 13). The second study indicated adequate reliability in patient samples of the PPT measures. In the third study, the PPT was significantly lower at sites producing referred pain on palpation compared to sites producing localized pain on palpation. The PPT findings from the control sites were inconsistent on this factor. The fourth study presented preliminary evidence that palpable bands and nodular areas in muscle were most commonly associated with muscle regions that produce pain; such muscle findings were not specific, however, for regions that produce pain. Further, the intraexaminer reliability in reassessing these pain sites qualitatively was only fair. Referred pain had a poor association with the pain pattern and physical findings, which may suggest a need to reevaluate part of the theory regarding referred muscle pain. The reliability of PPT measures was better overall than the reliability of the signs and site-specific symptoms, suggesting that pressure pain thresholds may be an important tool in clinical studies of pain. PPT measures demonstrate a high within-subject variability in pain patient subjects as well as non-pain subjects.(ABSTRACT TRUNCATED AT 400 WORDS)
Pain 1989 Nov
PMID:Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. 259 94

Referred pain originating from a dysfunctioning thoracic facet joint may simulate abdominal pain. This pain syndrome, the facet syndrome, is probably quite common and perhaps accounts for about 10% of the cases of abdominal pain of unknown origin. Current concepts of the facet syndrome are reviewed and a clinically diagnostic evaluation programme is presented. A case report illustrates the diagnostic problems in daily practice and the need for the clinician to recognize and to look for the facet syndrome.
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PMID:[Abdominal pain precipitated by thoracic segment syndrome]. 273 65

A retrospective review of 1293 cases of low back pain treated over a 12-year period revealed that sacroiliac joint syndrome and posterior joint syndromes were the most common referred-pain syndromes, whereas herniated nucleus pulposus and lateral spinal stenosis were the most common nerve root compression lesions. Referred pain syndromes occur nearly twice as often and frequently mimic the clinical presentation of nerve root compression syndromes. Combined lesions occurred in 33.5% of cases. Lateral spinal stenosis and herniated nucleus pulposus coexisted in 17.7%. In 30% of the cases of spondylolisthesis, the radiographic findings were incidental and the source of pain was the sacroiliac joint. Distinguishing radicular from referred pain, recognition of coexisting lesions, and correlation of diagnostic imaging with the overall clinical presentation facilities formulation of a rational plan of therapy. The above-outlined approach to managing low back pain evolved over a 12-year period. Designed to establish a specific diagnosis, it should yield excellent or good results in 84% of patients.
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PMID:Recognizing specific characteristics of nonspecific low back pain. 295 Oct 48

Part II of this two-part article reviews differential diagnosis of common geriatric knee disorders. Differentiating extra-articular from intra-articular causes of knee pain is stressed, since treatments and prognoses can be quite different. Referred pain from the ipsilateral hip and spine should also be kept in mind. The diagnostic approach to knee pain can be categorized anatomically and according to etiology: Is the pain coming from the bone (patella, femur, tibia, fibula), or the soft tissue (ligament, tendon, capsule, synovium, meniscus, muscle)? Is it degenerative, inflammatory, metabolic, traumatic, infectious, or neoplastic? These issues are included in the discussion.
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PMID:Geriatric knee disorders, Part II: Differential diagnosis and treatment. 334 69


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