CURRENT CONCEPT OF REFEERED PAIN

Obtained from Kellgren , Mooney and Anderson.

Reffered pain is

* a very diffuse sensation in their legs

* bilateral in nature

* not associated either with any radicular pattern or any root tension irritation or compression findings

* provided that those patients do not have spinal stenosis on CT scan or MRI, they probably have referred pain.

It is perceived as one of the two types of discomfort:

*deep discomfort felt in a sclerotomal or myotomal distribution

* it may be superficial in nature and felt within the skin dermatomes

Concept of trigger zones:

Somewhere in the nervous system is a convergence and summation of nerve impulses from the primary painful area. This is probably lamina 5 in the dorsal horn. The stimulation of this lamina opens a gate and allows central dispatch of the pain message and distal referral of other sensations that indicate referred pain. The essential feature of the relationship between the site of the pain and the distal referral is the common segmental origin of the sensory innervation for both the origin and the distal referral site. Some of that commonality may occur in the complicated ascending pathways in the spinal cord. You can increase the painful sensation by touching the sites of referred pain. These areas are known as trigger zones, and, through various methods of stimulation and anesthetization, referred pain can be altered.