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At least 91 records · Page 5Linked to original sources
PubMed1986

Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurones in trigeminal subnucleus caudalis (medullary dorsal horn) and its implications for referred pain.

Because of the likely involvement of central convergence of afferent inputs in mechanisms underlying referred pain, the activity of single neurones was recorded in the cat's trigeminal (V) subnucleus caudalis (medullary dorsal horn) to test for the presence and extent of convergent inputs to the neurones. In chloralose-anaesthetized or decerebrate unanaesthetized cats, electrical stimuli were applied to afferents supplying facial skin, oral mucosa, canine and premolar tooth pulp, laryngeal mucosa, cervical skin and muscle, and jaw and tongue muscles, and tactile and noxious mechanical and thermal stimuli were applied to skin and mucosa. Considerable proportions of caudalis neurones which could be functionally classified on the basis of their cutaneous receptive field properties as low-threshold mechanoreceptive (LTM), wide-dynamic-range (WDR), or nociceptive-specific (NS) neurones, could be excited by electrical stimulation of several of these afferent inputs. Extensive convergence of afferent inputs, including inputs from skin or mucosal areas outside the neuronal oral-facial receptive field delineated by natural stimuli, was a particular feature of the units classified as cutaneous nociceptive neurones (i.e., WDR and NS). On the basis of antidromic activation, 15% of these WDR and NS neurones were shown to have a direct projection to the contralateral thalamus. The findings question the use of terminology and classifications of somatosensory neurones based only on the cutaneous receptive field properties of the neurones since distinctions between the different neuronal populations become less obvious when properties other than those related to cutaneous afferent inputs are taken into account. Moreover, the observations of extensive convergence of different types of afferents, which was especially apparent in cutaneous nociceptive neurones, also suggest a role for these neurones in mediating deep pain and in spread and referral of pain.

Animals↗
PubMed1980

Local application of ketocaine for treatment of referred pain in primary dysmenorrhea.

In a randomized, double-blind cross-over study the effect on referred pain of the local anesthetic, ketocaine, was evaluated in 23 women suffering from primary dysmenorrhea. Ketocaine was administered in compresses containing 1 g ketocaine in a 10 per cent ethanol solution. The investigation comprised two consecutive menstrual periods. During one, the patient received ketocaine compresses, and during the other placebo compresses, i.e. compresses without ketocaine. The compresses were applied to the skin area where the patient experienced the most intense pain. When receiving ketocaine compresses, 19 of the 23 patients reported good or moderate pain relief. The effect was recognized within 30 to 60 minutes and lasted for a mean of 3 hours (range 1.5--5 h). Only four of the patients reported relief of pain when receiving placebo compresses. This effect ceased when the compresses were removed. No general side effects were registered. However, erythema at the site of compress application was more often observed after ketocaine than after placebo compresses.

Anesthetics, Local↗
PubMed1997

Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison.

OBJECTIVE: To investigate the occurrence of referred pain (ReP) elicited by palpation (Pal-ReP) or by needle injection (Inj-ReP) of myofascial trigger point (MTrP), and to assess the correlated factors, including the pain intensity of an active MTrP and the occurrence of local twitch response (LTR). DESIGN: Correlational study. PATIENTS: Ninety-five patients who were treated with MTrP injections. INTERVENTION: MTrP injections. MAIN OUTCOME MEASURE: Pain intensity of MTrP and occurrence of Pal-ReP, Inj-ReP, and LTR. RESULTS: Both Pal-ReP and Inj-ReP were elicited in 53.9% of MTrPs, Inj-ReP, but not Pal-ReP, was elicited in 33.7% of MTrPs. Both Pal-ReP and Inj-ReP were unobtainable in 12.3% of MTrPs. The occurrence of ReP was significantly correlated to the pain intensity of active MTrP and the occurrence of LTR. CONCLUSION: ReP could be elicited more frequently by needling than by palpation. The frequency of occurrence in ReP mainly depends on pain intensity of an active MTrP.

Adult↗
PubMed2001

Does stimulation of nasal mucosa cause referred pain to the face?

Ten healthy volunteers (five men and five women, mean age 30 years 3 months), with no nasal contact points, had pressure, adrenaline (1 : 1000), substance P (10 and 80 nmol/mL) and placebo topically applied to their nasal mucosa. Areas stimulated were the nasal floor, septum and lateral wall as well as the inferior and middle turbinates in both nasal cavities. The application of stimuli was randomized and single-blinded. A numerical score of the subjective severity of pain was used to assess outcome. Pressure caused variable local nasal discomfort limited by the duration of application and the site of pressure. Substance P caused variable nasal itching and sneezing. None of the stimuli caused referred pain to the face. The results question the role of mucosal contact points in facial pain.

Administration, Intranasal↗
PubMed1994

Initial assessment and follow-up by a physiotherapist of patients with back pain referred to a spinal clinic.

To reduce waiting times and costs, a specially trained physiotherapist was employed to review 100 patients with back pain referred by general practitioners (GPs) to a spinal clinic; 78% proved to have a spinal disorder. Only 24% of the original referrals needed to see the surgeon, with 76% being successfully managed by the physiotherapist. Six per cent of referrals were deemed inappropriate and 16% of patients failed to attend. To evaluate the physio-therapist's assessments each case was discussed with the consultant surgeon, and the appropriateness of the management of each patient was similarly investigated. With appropriate training and a good working relationship with the surgeon, a chartered physiotherapist can successfully screen patients in a low back pain clinic, such that the efficiency of the unit is improved by improving the throughput whilst maintaining the same standard of care.

Back Pain↗
PubMed1999

Diaphragmatic cramp as a possible cause of noncardiac chest pain and referred mandibular pain.

The initial assumption that sudden acute chest pain may be of cardiac origin is justifiable, but when this proves not to be the case the patient is left with little explanation of the cause. It is suggested here that diaphragmatic cramp may be a cause of some undiagnosed noncardiac chest pains associated with mandibular referred pain. The phrenic nerve provides both motor and sensory innervation to the diaphragm, while the trigeminal nerve carries sensation from the mandibular teeth. Both nerves originate in separate nuclei close together in the lower medulla. Interconnections between these nuclei and others higher up in the brain may provide one explanation for this problem.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Referred pain: a confusing case of differential diagnosis between two teeth presenting with endo-perio problems.

AIM: A case of a patient with a confusing referred pain is reported that emphasizes the importance of providing a differential diagnosis in order to avoid inappropriate treatment. SUMMARY: This article describes the management of a patient presenting with a combined endo-perio problem that was apparently treated adequately. After a short period of time, the reappearance of mild pain was misdiagnosed. The situation was more complicated when multiple diagnostic procedures were attempted and inadequate therapies were tried consecutively. When the true differential diagnosis was established and appropriate treatment provided, the symptoms disappeared and normal function returned. Diagnosis of teeth with necrotic pulps may be difficult to establish with possible reasons including inconclusive and poorly localized symptoms and signs. The situation can be further complicated if other teeth developing endodontic or combined endo-perio problems occur simultaneously as this may lead to misdiagnosis and treatment of the wrong tooth.

Adult↗
PubMed2002

Disc stimulation and patterns of referred pain.

STUDY DESIGN: Prospective, within-subjects, observational experimental design. OBJECTIVES: To determine the pattern of pain response to noxious stimulation of the intervertebral disc. SUMMARY OF BACKGROUND DATA: Experimental studies have demonstrated that noxious stimulation of interspinous ligaments, facet joints, and paravertebral muscles causes referred pain into the extremity, with the distal extent of radiation dependent on the intensity of stimulation. Analogous studies have not been performed on the lumbar intervertebral disc. METHODS: A total of 25 consecutive patients meeting inclusion criteria completed a pain diagram before undergoing the intradiscal electrothermal annuloplasty procedure. The location, intensity, and familiarity of any pain provoked during disc heating were correlated with presenting symptoms and duration of heating. RESULTS: During disc heating, 68% of patients reported exact reproduction of their presenting pain, in both pain quality and location. None of the patients experienced unfamiliar pain during the procedure. The pattern of pain reproduction was consistent; pain originated proximally and progressed distally as stimulus intensity increased. CONCLUSION: Noxious stimulation of the intervertebral disc may result in low back and referred extremity in patients presenting with these symptoms. The distal extent of pain produced depends on the intensity of stimulation. Disc stimulation may reproduce pain that extends to below the knee.

Catheterization↗
PubMed2001

Meningeal nociception: electrophysiological studies related to headache and referred pain.

Headaches, which are usually referred to characteristic sites of the skull, are believed to involve meningeal nociceptors located in the dura mater encephali. Animal experiments show that these meningeal nociceptors are polymodal and usually highly sensitive to mechanical stimulation. These properties are also characteristic for the second order neurons in the spinal trigeminal nucleus, most of which receive convergent input from facial receptive sites. Sensitization of primary and secondary neurons by chemical irritants to mechanical stimuli may be an important mechanism in the generation of headaches. The convergent input from extracranial structures, which seems to be differentially organized in rodents and man, may explain the typical features of referred headache. Targets for analgesics used in the therapy of headaches (non-steroidal antiinflammatory drugs, 5-HT(1) receptor agonists) are probably meningeal nociceptors and different sites of the central trigeminal nociceptive and antinociceptive pathways.

Afferent Pathways↗
PubMed1981

Do dichotomizing afferent fibers exist which supply visceral organs as well as somatic structures? A contribution to the problem or referred pain.

Fibers in the inferior splanchnic nerves were found which could be activated by electrical stimulation of one of the lumbar white rami as well as of the somatic nerve of the same spinal segment at stable latency. The responses of these fibers reliably followed high frequency stimulation (20-100 Hz) of the nerves. The axons were unmyelinated (conduction velocity 1.02 +/- 0.57 m/sec, mean +/- 1 S.D., n = 14), had no ongoing discharges and could not be excited by afferent stimuli via a spinal or supraspinal reflex pathway. Therefore, it is likely that these fibers are afferent. The findings support the hypothesis that referred pain may be produced by dichotomizing sensory fibers, one branch passing to visceral organs and the other branch to the site of reference in muscle or skin.

Afferent Pathways↗
PubMed1986

Referred pain and tender points.

A diffuse distribution of characteristic sites of tenderness is recognized to be a distinctive feature of the fibromyalgia/fibrositis syndrome, and is often associated with general symptoms such as exhaustion, stiffness, and irritability to external and internal stimuli. Equally important, and more common, is the development of similar tenderness at precisely the same sites in referred pain syndrome. The distribution of points is clumped, i.e., restricted to the appropriate region, and the general symptoms are lacking. The usual sites of origin are often unknown to the patient, because they lie deep in the cervical or lower lumbar spine. The clumped pattern of points is therefore very helpful in diagnosis and therapy.

Back Pain↗
PubMed1998

Regional correspondence between the ventral portion of the lumbar intervertebral disc and the groin mediated by a spinal reflex. A possible basis of discogenic referred pain.

STUDY DESIGN: Lumbar peripheral nerves were examined to determine whether they were responsive to electrical stimulation of the ventral portion of the lumbar disc in anesthetized rats. OBJECTIVES: To confirm by electrophysiologic means the neural correspondence between the ventral portion of the lumbar disc and the groin. SUMMARY OF BACKGROUND DATA: Patients with a degenerated lumbar disc occasionally report groin pain. However, its pathogenesis has not been investigated. The authors of the current study found that chemical stimulation of the ventral portion of rat lumbar disc caused cutaneous plasma extravasation in the groin, and thereby hypothesize the neural relation between the lumbar disc and the groin. METHODS: The ventral portion of rat L5-L6 disc was electrically stimulated, and the elicited action potentials were recorded from the iliohypogastric, genitofemoral, lateral femoral cutaneous, sural, and sciatic nerves. The roles of the lumbar sympathetic trunks and spinal cord in the generation of the action potentials were examined. RESULTS: Action potentials were elicited principally in the genitofemoral nerve; the action potentials of the genitofemoral nerve were not influenced by transection of the cervical spinal cord, whereas they disappeared immediately after death, which indicates that they are induced by a spinal reflex. The action potentials were reduced considerably after destruction of the lumbar sympathetic trunks, suggesting that they comprise an afferent path of the reflex. CONCLUSIONS: The ventral portion of the lumbar disc had spatial relation to the groin area via a spinal reflex. Such a relation suggests that a disorder in the ventral portion of the lumbar disc may be a possible source of groin referred pain.

Action Potentials↗