Overview of the

physiology of
referred pain
Lecture outcomes

u Mechanisms of Referred Visceral Pain

u Multisegmental Innervations
u Assessment of Pain and Symptoms
u Sources of Pain
u Types of Pain
u Comparison of Systemic Versus Musculoskeletal Pain
u Patterns
Overview of referred pain

u At least four physiological mechanisms have been

proposed to explain referred pain:
u (1) activity in sympathetic nerves,
u (2) peripheral branching of primary afferent nociceptors,
u (3) convergence projection, and
u (4) convergence facilitation.
u The latter two involve primarily central nervous system
mechanisms.
Mechanisms of Referred Visceral Pain

u Not well understood

u Somatic sensory input basis

u Based on
u 1. Embryological development
u 2. Multisegmental innervation
u 3. Direct pressure/shared pathways
Referred pain

u Referred pain is pain perceived at a location other than the site of the
painful stimulus/ origin.

u It is the result of a network of interconnecting sensory nerves, that

supplies many different tissues.

u When there is an injury at one site in the network it is possible that when
the signal is interpreted in the brain signals are experienced in the
surrounding nervous tissue.
u This however should not be confused with radiating or radicular pain
which is the pain brought on by anomalous discharges coming from a
dorsal root or its ganglion.

u Radicular pain can be caused by intervertebral disc

herniation, Spondylosis, Spondylolisthesis, or any condition which
involves the compression of the dorsal root ganglion.
Assessment of Pain
Thank you