Guest Editorial: referred pain

Murray, Greg M.

doi:10.1590/s1678-77572009000600001

Cited by 12 publications

(8 citation statements)

References 1 publication

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“…14 However, with prolonged or intense nociceptive stimulation, previously latent secondorder neurons become activated, and information from regions unrelated to the source of the noxious peripheral stimulus may be conveyed to higher centers of the brain. 9,14 Others postulate that sympathetic nerves may cause referred pain by sensitizing nociceptors or restricting blood flow in the region of referred pain. 15 One theory widely considered as a cause of hyperallodynia, the central sensitization theory, may also play a role in referred pain.…”

Section: Mechanisms Of Referred Painmentioning

confidence: 99%

Secondary Otalgia: Referred Pain Pathways and Pathologies

Norris

Koontz

2020

AJNR Am J Neuroradiol

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Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for potential sources of referred ear pain (secondary otalgia). Innervation of the ear structures is complex, involving multiple upper cervical, lower cranial, and peripheral nerves, which transit and innervate a large anatomic territory involving the brain, spine, skull base, aerodigestive tract, salivary glands, paranasal sinuses, face, orbits, deep spaces of the neck, skin, and viscera. Interpreting radiologists must be familiar with these neural pathways and potential sources of secondary otalgia. The purposes of this review are to detail the currently proposed mechanisms of referred ear pain, review the salient neuroanatomy of the complex pathways responsible for secondary otalgia, highlight important benign and malignant etiologies of referred ear pain, and provide a structured search pattern for approaching these challenging cases on cross-sectional imaging.

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Section: Mechanisms Of Referred Painmentioning

confidence: 99%

Secondary Otalgia: Referred Pain Pathways and Pathologies

Norris

Koontz

2020

AJNR Am J Neuroradiol

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“…However it could be explained by the Hiltons law applied to the musculocutaneous nerve (MCN). The mystery of a subset of patients with shoulder pain could also be explained by the existence of interconnections between MCN and MN as described in cadaveric studies (16).…”

Section: Discussionmentioning

confidence: 99%

“…This could be triggering the brain to misinterpret the shoulder as a site of origin of the pain (17). Another theory of unmasking the shoulder pain pathways following activation of these pain fibres at the wrist level could be adopted from the original description (18). Moreover, the individual variations in perception of shoulder pain may be explained by combination of all these mechanisms or in different combinations and/or in different intensity.…”

Section: Limitationsmentioning

confidence: 99%

Carpal tunnel syndrome with shoulder symptoms; is it a different entity? A prospective cohort study comparing recovery patterns following decompression

Ekanayake

Manilgama

2023

Asian J. Internal Med.

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Background: Carpal tunnel syndrome (CTS) may present with atypical proximal symptoms other than hand symptoms.Among proximal symptoms, shoulder symptoms are most distant to the site of compression and leads to a battery of investigations to exclude other pathologies. The recovery patterns of proximal symptoms have not been studied following carpal tunnel decompression. Methods: A prospective cohort study was conducted to compare the recovery patterns between subgroup-A; CTS patients (n=55) with shoulder symptoms, with subgroup-B; patients (n=55) without shoulder symptoms. A pre-tested questionnaire was administered prior and after the surgery and information was gathered on day-7, day-14 and day-21. Results: Of 110 patients, 81.8% were females. The mean age(+SD) of the total population was 49.2(+10.6), that of subgroup-A was 48.7(+10.3), and subgroup-B was 49.7(+11) years. They were predominantly right-handed (82.7%), 73% had their dominant hand affected while 74.5% were affected bilaterally at presentation. All had hand symptoms: numbness in 94.5%, pain in 85.4%, tingling of hand in 66.3% and all-three symptoms in 57.2%. In subgroup-A, pain was the predominant shoulder symptom which appeared before hand symptoms in 34.5%, after in 47.3% and simultaneously in 18.2%. It was aching-type in 91%. The pain radiated proximally (neck and scapula) in 61.8% and to the arm in 81.8%. The recovery rates (RR) of hand symptoms following decompression on day-7 were 41.8% in subgroup-A and 40.0% in subgroup-B. RR of hand symptoms in subgroup-A and subgroup-B on day-14 were 72.7% and 70.9%, while on day-21 were 83.6% and 85.5% respectively. RR of shoulder symptoms in subgroup-A were 38.2% on day-7, 65.4% on day-14, and 78.2% on day-21. Conclusions: Near identical RR of hand and shoulder symptoms were seen between the two subgroups after decompression, which indicates CTS with shoulder symptoms is not a different entity.

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“…The present case series highlights the importance of the first use of less invasive SCP block over conventional more invasive interventions in managing the pain of cervical spine origin. The above three patients appeared to have had pain generator in degenerative cervical spine and para cervical structures (ligaments, musculature, facet joint, osteophytes or degenerative tissue)[ 1 3 ] with pain transmission to neck, facial or/and mandibular regions. Interestingly, MRI revealed disc herniation at C5–C6 and C6–C7 intervertebral space, but the pain was distributed to C1–C4 area in the neck and face.…”

Section: Discussionmentioning

confidence: 99%

“…Referred pain is defined as an entity where pain is felt in the distribution of a nerve that does not belong to the actual source of pain, although the nerves share the same spinal cord segment as that of the pain source. [ 1 ] We present a case series of three patients with chronic unilateral cervical origin pain, moderate-to-severe in intensity and being referred to the neck and facial region.…”

Section: Introductionmentioning

confidence: 99%