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At least 73 records · Page 4Linked to original sources
PubMed2005

Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle.

BACKGROUND: Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. OBJECTIVE: To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). DESIGN: A blinded, controlled study. METHODS: The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. RESULTS: Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). CONCLUSIONS: MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.

Adult↗
PubMed1991

A comparison of the effects of two sitting postures on back and referred pain.

This study compared the effects of sitting with portable supports in either a kyphotic or lordotic posture on low-back and referred pain. Two hundred ten patients with low-back and/or referred pain were randomly assigned to either a kyphotic posture or lordotic posture group. The kyphotic and lordotic postures were facilitated by the use of a flat foam cushion or lumbar roll, respectively. Pain location, back pain, and leg pain intensity were assessed over a 24-48-hour period under both standardized clinical settings and general sitting environments. When sitting with a lordotic posture, back and leg pain were significantly reduced and referred pain shifted towards the low back. This study demonstrates that in general sitting environments a lumbar roll results in: 1) reductions in back and leg pain; and 2) centralization of pain. These findings do not apply to patients with stenosis or spondylolisthesis, whose symptoms may be aggravated by use of a lumbar roll.

Adult↗
PubMed2005

Somatosensory changes in the referred pain area in patients with cholecystolithiasis.

BACKGROUND AND AIMS: Patients with abdominal pain provoked by acute cholecystitis increase the somatic sensitivity in the referred somatic pain area. Our aim in the present paper was to examine somatosensory changes in the referred pain area (previously evoked by painful attacks) in patients with uncomplicated gallstone disease and to evaluate the possible relation between referred pain patterns and clinical findings. Somatosensory changes in these areas may be important in the persistent pain after treatment and may help to develop treatment strategies for abdominal pain in the post-cholecystectomy syndrome. SUBJECTS: Forty-two patients with symptomatic cholecystolithiasis, confirmed ultrasonographically, were studied in the pain-free period. METHODS: Sensitivity and pain thresholds for standardized experimental sensory testing including different modalities: pinprick, pinching, heat, cold, pressure, and single and repeated electrical stimulation were studied in the area where the pain was referred to during the acute attacks, and in a control area on the contralateral side of the abdomen. RESULTS: Patients with verified cholecystolithiasis showed hyperalgesia to pinprick (26% of subjects, P < 0.05) and cold stimuli (21% of subjects, P < 0.05) in the referred pain area. There was also a significant reduction in sensation/pain thresholds (indicating hyperalgesia) in the referred pain area to single (P = 0.007/P = 0.002) and repeated electrical (P = 0.017/P = 0.043) stimuli, as well as in pain threshold to pinching and mechanical stimuli (P = 0.049/P < 0.001). There were no significant relations between the hyperalgesia and the clinical findings. CONCLUSION: Cholecystolithiasis leads to significant hyperalgesia in the somatic area, where pain was referred to during the acute attacks. This is explained by viscero-somatic convergence mechanisms in the central nervous system. Therefore, central neuroplastic changes may be significant in diseases related to the gallbladder such as the post-cholecystectomy syndrome.

Acute Disease↗
PubMed1995

Visceral pain, referred hyperalgesia and outcome: new concepts.

Visceral pain is a poorly defined, midline sensation but after minutes or hours becomes 'referred' to a somatic region when it becomes sharper and better localized. Referred pain may manifest either with or without hyperalgesia. Hyperalgesia is more common and can be demonstrated by changes in pain threshold. This referred hyperalgesia is probably sustained by central mechanisms, involving a spinal focus facilitating neuronal signals coming from somatic structures. Once established, the central changes may become independent of the peripheral input necessary for their initiation. With respect to post-surgical pain associated with operations on the viscus, the main determinant is whether or not the visceral pathology prior to surgery was algogenic.

Humans↗
PubMed2005

Possible mechanism of referred pain in the perineum and pelvis associated with the prostate in rats.

PURPOSE: Since persistent pain in the perineum and pelvic floor associated with chronic prostatitis /chronic pelvic pain syndrome has been hypothesized to be referred pain, it might also be explained by neural mechanisms. MATERIALS AND METHODS: Dual retrograde fluorescent labeling and immunohistochemistry were identified as methods with which to investigate the neurogenic aspect of this status. The dual distribution of dorsal root ganglia (DRG) cells was determined after double retrograde fluorescent staining of the prostate and pelvic floor, and the prostate and perineum somatic nerves. Calcitonin gene-related peptide (CGRP) and substance P (SP) in dual labeled cells were determined by immunohistochemistry, giving possible insight into the cause of pelvic pain. RESULTS: Fluorescent double labeled cells were found in the lumbar and sacral DRG, while double labeled cells were distributed predominantly in L6 to S1 and L1 to L2 segment DRG in groups 1 and 2, respectively. On immunohistochemistry some of them were confirmed to contain CGRP and SP. Thus, there are crossover pathways between the prostate and pelvic floor. CONCLUSIONS: The findings that we present confirm that the peripheral process of DRG cells dichotomizes to the prostate, sphincter and somatic parties simultaneously. Some of these cells contain CGRP and SP, which indicate that referred pain in the perineum and pelvic floor may be caused by an axon reflex in the peripheral process of DRG neurons.

Animals↗
PubMed1997

Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami.

OBJECTIVE: The purpose of this study was to determine the distribution of referred pain from the lumbar zygapophyseal joints (L1/2 to L5/S1) and the medial branches of the lumbar dorsal rami (Th12 to L5) in a large number of patients with chronic low back pain. SETTING: This study was conducted at the pain clinics of Kanto Teishin Hospital and Hannan Central Hospital from March 1994 to May 1996. PATIENTS AND DESIGN: Chronic low back pain patients who underwent zygapophyseal joint injection or radiofrequency facet denervation were studied. Under fluoroscopic control, the joints from L1/2 to L5/S1 were stimulated by injection of contrast medium, and the lumbar medial branches of the dorsal rami from Th12 to L5 underwent electrical stimulation during radiofrequency facet denervation. OUTCOME MEASURES: If the injection or electrical stimulation reproduced the patient's usual pain, the distribution of induced pain was determined, and the sites of induced pain were divided into six areas. RESULTS AND CONCLUSIONS: A total of 71 joints and 91 medial branches were studied in 48 patients. The distribution of referred pain from the L1/2 to L5/S1 zygapophyseal joints, and the medial branches of the dorsal rami from L1 to L5 were similar for each level stimulated, and the overlap of referred pain between each level was considerable.

Adult↗
PubMedDate not supplied

Referred pain to the ipsilateral forehead and orbit: An unusual phenomenon during bronchial artery embolization.

PURPOSE: We report an unusual pattern of referred pain to the ipsilateral forehead and orbit observed during bronchial artery embolization (BAE) for massive hemoptysis due to pulmonary tuberculosis (TB) and postulate possible neural mechanisms for its occurrence. METHODS: Seven men, from a series of 194 patients (171 men, 23 women) undergoing BAE (right bronchial artery 4, left 3) with gelatin sponge for control of massive hemoptysis due to pulmonary TB form the subject of this report. RESULTS: Embolization was successful in achieving control of hemoptysis in these patients and there were no complications following the embolization. Transient, moderately severe, ipsilateral supraorbital and/or retroorbital pain occurred only during the injection of the gelatin sponge contrast mixture into the bronchial artery. The pain did not occur during the injection of heparinized saline or ionic contrast medium. CONCLUSIONS: Referred pain during BAE is an unusual phenomenon. Acute vessel distension triggering visceral sensations is probably the causative mechanism. Sympathetic afferents from the bronchi coursing through the posterior pulmonary plexus eventually pass to the trigeminal ganglion via the carotid sympathetic chain. The ophthalmic and maxillary divisions of the trigeminal nerve then mediate pain sensation to the ipsilateral forehead and orbit. Similarly, parasympathetic afferents from the pulmonary plexus crossing the nucleus of the spinal tract of the trigeminal nerve may be responsible for interexchange of impulses to the neurons in this nucleus. Sensory fibers of the ophthalmic and maxillary nerves relaying in this nucleus are then involved in this pain being referred to the forehead and orbit.

Adult↗
PubMed1984

Referred pain from intraneural stimulation of muscle fascicles in the median nerve.

Microelectrode recordings were obtained from 118 cutaneous and 26 muscle fascicles in the intact median nerves of healthy human subjects. The exploring electrodes were also used for painful electrical stimulation of the identified fascicles. Cutaneous pain was accurately projected to fields within the median innervation territory. Deep pain was projected to muscles innervated by the median nerve, but in 7 experiments it was also segmentally referred to muscles in the ipsilateral upper arm, axilla or chest. Reaction time measurements indicated that referred pain was conveyed by afferent group III fibres from muscle, but did not exclude a possible contribution by group IV fibres. Referred pain was influenced by temporal and spatial summation of the afferent inflow. The magnitude of referred pain was positively correlated to the stimulation frequency of deep nociceptive fibres. The results from this study on experimentally induced pain confirm clinical observations of proximal referral of pain in patients with median nerve entrapment, and prompt consideration of possible involvement of nerve fascicles supplying deep structures in the forearm or hand in the differential diagnosis of pain in the chest and upper arm.

Adult↗
PubMed2002

Somatosensory changes in the referred pain area following acute inflammation of the appendix.

BACKGROUND AND AIMS: Abdominal pain provoked by acute gastrointestinal disease may increase the sensitivity in the referred somatic pain area. The aim of this study was to examine sensory changes in the referred pain area during acute appendicitis. SUBJECTS: Twenty patients with clinical symptoms of appendicitis were included; 16 of these had appendicitis confirmed at operation. Ten healthy volunteers served as controls. METHODS: In patients with symptoms of appendicitis, somatic sensitivity was assessed using different stimuli presented in the area of referred pain and in a comparable non-painful area at the contralateral site of the abdomen. In healthy control subjects, the same stimuli were presented to McBurney's point and at a similar area on the left abdomen. The rating to pinprick was determined using a Von Frey hair. The rating to thermal stimuli was tested by warm and cold metal rollers. A constant current stimulator was used to measure the sensation and pain-detection threshold to single and repeated electrical stimuli. The pressure pain threshold was determined by an electronic pressure algometer. RESULTS: Patients (n = 16) with verified appendicitis showed increased ratings to pinprick (50%, P < 0.05) and thermal stimuli (56%, P < 0.05) in the referred pain area. There was a reduction in pain thresholds to single electrical (4.3 v. 8.4 mA, P = 0.001), repeated electrical (3.5 v. 4.6 mA, P = 0.005) and pressure (89 v. 243 kPa, P < 0.001) stimuli in the referred pain area versus the control area. In the control group, no difference was observed between the two areas. The pain thresholds for electrical and pressure stimuli were lower in the referred pain area in patients compared with the same area in controls (P < 0.001). CONCLUSION: Somatosensory hyperalgesia to experimental stimuli was observed in acute appendicitis. We believe that viscerosomatic convergence mechanisms and central nervous system hyperexcitability explain these findings.

Abdominal Pain↗
PubMed2000

Intramuscular and intradermal injection of capsaicin: a comparison of local and referred pain.

The present study compared capsaicin-induced muscle and skin pain in humans. Twelve healthy subjects received, in a randomised, balanced order, 3 intramuscular (i.m.) injections into the brachioradial muscle: capsaicin 100 microg/1 ml, capsaicin 100 microg/20 microl or 1 ml solvent (Tween 80), and one intradermal injection (i.d.): capsaicin 100 microg/20 microl. Local and referred pain intensities and areas were assessed from 0 to 60 min after injection. Intradermal capsaicin produced more intense local pain than i.m. capsaicin in the first min (skin: 68+/-6, muscle: 51+/-6 mm VASxmin, P<0.05). In contrast, the local pain offset was later (muscle: 38+/-5, skin: 23+/-5 min, P<0.05) and referred pain was more frequent (muscle: 9/12, skin: 1/12 subjects, P<0.01) following i.m. capsaicin compared with i.d. capsaicin. Capsaicin (1 ml) produced significantly more pain than 20 microl i.m. (pain in the first min: 1 ml: 71+/-6, 20 microl: 51+/-6 VASxmin, P<0.05, offset: 1 ml: 50+/-4, 20 microl: 38+/-5 min, P<0.05). The different local and referred pain following identical noxious stimulation of muscle and skin indicates that the neurophysiological mechanisms underlying skin and muscle pain differs. The model with identical noxious stimulation of muscle and skin may be suitable for the study of differences in deep and superficial pain as seen in the clinic.

Adult↗
PubMed1997

A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence.

STUDY DESIGN: The presence or absence of rapidly centralizing, peripheralizing, or abolishing low back and radiating pain, as identified during a McKenzie mechanical lumbar assessment of patients with chronic lumbar pain, was compared prospectively with discographic pain provocation and anular competency. OBJECTIVES: To evaluate any relation between the responses of centralization and peripheralization with discographic findings. SUMMARY OF BACKGROUND DATA: Centralization of referred pain has been reported as a very common occurrence during McKenzie assessment and treatment. Patients whose pain centralizes have been shown to achieve superior treatment outcomes. A dynamic internal disc model has been hypothesized as an underlying mechanism for centralization that has not been studied previously. METHODS: Patients with chronically disabling low back pain who were referred for discography underwent preliminary blinded McKenzie clinical assessment and were categorized into three groups by their pain response. Patterns, or lack thereof, of pain response were then compared with blinded discographic pain provocation and anular findings. RESULTS: During the McKenzie assessment, the referred pain of 50% centralized with 74% having positive discograms, of which 91% had an intact anulus. The pain of 25% peripheralized only (would not centralize); 69% of these had positive discograms, but only 54% had an intact anulus. The distal pain of 25% did not respond at all, and only 12.5% of these had positive discograms. CONCLUSION: The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P < 0.001) as well as competent from an incompetent anulus (P < 0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs.

Adult↗
PubMed2005

Referred pain pattern of the pronator quadratus muscle.

Pain patterns of the myofascial trigger points (TrP) for most muscles of the forearm have been documented. However, there are no published reports on the referred pain patterns for the pronator quadratus (PQ) muscle. The purpose of this study was to determine the referred pain pattern of the TrP in the PQ. Thirty-five arms of 35 healthy adult volunteers with no history of neck pain, arm pain or paresthesia were studied. Following skin sterilization, a Teflon-coated syringe needle was inserted into the PQ of the non-dominant forearm under electromyographic guidance, and 0.3mL of 6% hypertonic saline was injected. Subjects drew in their pain areas on a pain diagram, and this drawing was transferred into the Pain Chart System for analysis. Two main pain patterns were observed. The most common pattern involved pain spreading both distally and proximally from the injection site, along the medial aspect of the forearm (57%). In half of these cases, the pain area extended to the medial epicondyle proximally and the fifth digit distally. The second main pattern revealed pain spreading distally to the third and/or fourth finger (29%). The pain patterns originating from the PQ resemble the C8-T1 dermatomes, and ulnar and median nerve sensory distributions. Thus, myofascial pain of the PQ should be considered as a possible cause of pain in the medial forearm and hand, especially when no other neurological abnormalities are present.

Adult↗
PubMed1982

TMJ symptoms and referred pain patterns.

The purpose of this study was to determine the relationship between TMJ symptoms, (muscle tenderness, joint noise, deviant jaw opening and closing patterns, and limited jaw opening), and a history of referred pain patterns (earaches, headaches, neck pain, and sinus problems). A questionnaire was completed by 100 subjects regarding histories of the previously mentioned problems. The researcher then examined the subject's TMJs, and their symptoms were recorded as being present or absent. The following relationships were found to be significant: Headaches and lateral pterygoid muscle tenderness, Earache and medial pterygoid muscle tenderness, Neck pain and one or more tender muscles, Sinus problems and one or more tender muscles, Sinus problems and temporal muscle tenderness, Sinus problems and medial pterygoid muscle tenderness. However, r values for the above relationships were between 0.22 and 0.3 indicating that the relationships were not strong. It appears that some normal patients already have patterns of masticatory muscle tenderness and associated referred pain patterns prior to seeking treatment for acute TMJ symptoms.

Adult↗
PubMed1988

Unilateral facial pain in patients with lung cancer: a referred pain via the vagus?

In 8 patients presenting with unilateral facial pain, subsequent investigation revealed an ipsilateral lung tumour. The interval between presentation with the pain and the discovery of the lung cancer varied between 6 wk and 4 yr. Radiotherapy cured the facial pain in 7 cases. Facial pain may be caused by lung cancer, and could be referred to the face via the vagus nerve.

Adult↗
PubMed1983

Compressive, invasive referred pain to the shoulder.

The painful shoulder can be the presenting complaint of a wide variety of local, as well as systemic, problems. Compression of the brachial plexus or occlusion of the subclavian vessels caused by narrowing of the thoracic outlet is best diagnosed by a thorough history and physical examination, and by performing the appropriate test maneuvers. Patients who do not respond to an exercise program to strengthen the shoulder girdle may require surgical excision of the first rib to enlarge the thoracic outlet. Referred pain in the shoulder originating from the cervical spine or peripheral nerves can be determined by cervical spine roentgenograms and nerve conduction tests. Neoplasms and parenchymal disease of the lung, and infections of the pleural and subdiaphragmatic areas can refer pain to the shoulder through the phrenic nerve. For those patients with persistent shoulder pain and no discernible musculoskeletal abnormalities who do not respond to standard therapeutic measures, another source of the shoulder pain should be sought.

Diagnosis, Differential↗
PubMed1997

Temporal summation in muscles and referred pain areas: an experimental human study.

The aim of the present study was to assess temporal summation within saline-induced, localized and referred muscle pain areas. The sensibility to single and repeated electrical stimuli were assessed in the muscle by means of needle electrodes and in the referred pain area by surface stimulation. The study demonstrates that temporal summation of nociceptive input from muscles exists and that the responses to single and repeated nociceptive stimuli of the referred pain area are facilitated.

Electric Stimulation↗
PubMed1999

A case of referred pain evoked by remote light touch after partial nerve injury.

An unusual case of referred pain is presented in which a 63-year-old man, who suffered a severe injury to his right hand and arm during young adulthood, describes the later development of dysesthesia and shooting pain in his arm subsequent to stimulation of the ipsilateral scalp, the temporal and infrazygomatic region of the face, and the back. Referred sensations of this type are usually reported following amputation of an arm. Clinical examination of the sensory and motor function of the arm and hand revealed partial damage to the radial, ulnar and median nerves as well as possible brachial plexus involvement. Interestingly, pain could be evoked by repeated light touches applied to the remote trigger areas suggesting the involvement of a 'wind-up'-like process.

Arm↗