Referred Pain

What is the definition of referred pain?

Pain felt in the skin or somatic tissue whose sensory fibres enter the spinal cord at the same segmental level as pain fibres from the affected viscera

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Why can pain be referred?

Pain can be referred because signals travel through the same nerve pathways going to the brain

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What is the connection between autonomic afferent fibres & sympathetic/parasympathetic fibres?

Autonomic (visceral afferent) fibres enter the CNS only where sympathetic or parasympathetic (visceral efferent) motor fibres leave it

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What are the features of visceral pain?

Fewer sensory endings, often found in smooth muscle, poorly localised and produce a dull, heavy or gripping pain

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What are the features of somatic pain?

Pain from skin, many sensory receptors, well localised & produce a sharp pain

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What is the difference between autonomic motor & sensory fibres?

Unlike autonomic motor (efferent) fibres, autonomic sensory (afferent) fibres do not have peripheral synapse. Enter CNS along dorsal nerve root. Also applies to somatic afferents i.e. body wall.

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Where do visceral afferents enter the spinal cord?

T1-L2 (equivalent to sympathetic motor outflow), S2/3/4 (equivalent to sacral parasympathetic outflow) & cranial nerves IX and X

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Where is pain referred for the appendix, bladder, diaphragm, oesophagus, heart & intestines?

Appendix: right lower quadrant, umbilicus. Bladder: lower abdomen, upper thigh. Diaphragm: anterior shoulders. Oesophagus: along sternum, left upper thorax. Heart: base of neck, left jaw/shoulder/arm. Intestines: back (ache or sharp), umbilicus

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Where is pain referred for the kidneys, liver, pancreas, spleen & ureter?

Kidney: high in post costovertebral angle, radiates forward. Liver: right shoulder. Pancreas: directly behind, lower left quadrant, umbilicus. Spleen: left shoulder, upper 1/3 arm. Ureter: costovertebral angle, radiates to low abdo/testes/inner thigh

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Referred Pain

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