Referred pain

Introduction In some internal organs, a phenomenon of hyperesthesia or painful sensation occurs in a certain area of the body surface, which is called pain. For example, in the early stage of appendicitis, pain often occurs in the upper abdomen or around the umbilicus, myocardial ischemia or infarction, often feeling pain in the anterior region, left shoulder, left arm ulnar or left neck surface, often in the right shoulder when gallbladder disease Pain occurs on the body surface. The pain involved is a type of pain in which the patient feels a significant pain in the body surface and there is no actual damage. This is because the nerve fibers of the diseased viscera and the nerve fibers somewhere on the body surface meet in the same spinal segment. The afferent nerve fibers from the viscera, in addition to the cerebral cortex on the spinal cord, respond to visceral pain and affect the same spinal segment. The surface nerve fibers, which conduct and spread to the corresponding body surface, cause pain.

Cause

1 Convergence projection theory, which was proposed by Ruch in 1947. According to this theory, pain is caused by the convergence of skin and visceral nociceptive afferents at the level above the spinal cord and spinal cord. The sensory area of the cerebral cortex is visceral. The space of pain cannot be accurately located, but it is good at distinguishing the body surface, so the central projection of the visceral pain impulse is often reflected in the body surface area. The convergence of neurons in the spinal cord, thalamus, and cortex is the basis of this theory.

2 Convergence Yichemistry said that this theory believes that skin and visceral nociceptive afferents are converged in the spinal cord, and visceral painful input produces an "stimulus" in the spinal cord, facilitating normal information from the body structure, thereby causing pain. Inflammation of internal organs can lead to central sensitization of neurons in the dorsal horn of the spinal cord. At this time, the visceral and body input signals are facilitated. This process is similar to the central sensitization mechanism when stimulating the body, possibly in the area of hyperalgesia. The phenomenon plays an important role. It is currently believed that the involvement of pain is related to both mechanisms.

an examination

Related inspection

Magnetic resonance imaging (MRI) blood routine

Refers to visceral pain involving the body surface. It is the pain caused by the abdominal organs, stimulates the transmission of the splanchnic nerve, affects the corresponding spinal segment and is located on the body surface, that is, it has more characteristics of somatic nerve conduction, the pain is strong, the degree is severe, the part is clear, and the local has tenderness and muscle. Nervous and allergic to the skin.

Involving sexual pain, such as gallbladder disease, in addition to right upper quadrant pain, there is pain in the right shoulder and armpit. In addition to this side of the kidney, the kidney stones have pain in the inner side of the thigh and the perineum.

Clinically, abdominal pain in many diseases involves a variety of mechanisms, such as early appendicitis in the umbilical or upper abdomen, often nausea, vomiting, and visceral abdominal pain.

As the disease progresses, persistent and intense inflammatory stimuli affect the somatic afferent nerves of the corresponding spinal segments, causing pain and pain transfer to the right lower abdomen.

When inflammation develops further into the peritoneal wall layer, somatic pain occurs, with severe degrees of tenderness, muscle tension and rebound tenderness.

Differential diagnosis

Involving pain symptoms need to be differentiated from radiation pain

Radiation pain, also known as root pain, refers to the pain of a patient's body surface or deep tissue away from the organ in addition to the local pain of the diseased organ. Clinical lumbar disc herniation and spinal stenosis are the most common. The location of this pain is clear, the pain is an electric shock, and changes in sensory and motor function are often seen.

In some internal organs, a phenomenon of hyperesthesia or painful sensation occurs in a certain area of the body surface, which is called pain. For example, in the early stage of appendicitis, pain often occurs in the upper abdomen or around the umbilicus, myocardial ischemia or infarction, often feeling pain in the anterior region, left shoulder, left arm ulnar or left neck surface, often in the right shoulder when gallbladder disease Pain occurs on the body surface.

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