"What is it?!"
As primary health care practitioners, osteopaths are often presented with a multitude of different conditions. While most forms of pain are experienced physically, not all pain is the kind requiring osteopathic intervention. Pain can also signify an underlying condition. This is why practitioners obtain a thorough clinical history and why being upfront with your osteopath is vital!
A patient’s pain may not even be of musculoskeletal (tissue or joint related) origin even though it is experienced that way!
Pain of this nature is known as referred pain. It is experienced in a location away from, and different to, where it originates’ (Alvarez et al., 2002). All nerves originate from a level of the spinal cord and each becomes part of a network supplying many different tissues. When there is an injury at one point in the network, the signal is registered by the brain from the spinal level of that given nerve. But that spinal-level nerve doesn’t know exactly what tissue is affected. As such, pain will often be distributed across much of the level to ‘...protect that region of the body from further harm and as an alert that injury has occurred’ (Arendt-Nielsen & Svensson, 2001).
Referred pain is a large umbrella term; there are several subcategories of how pain like this may be experienced and the mechanisms of how it occurs. Falling beneath this category is viscerosomatic pain.
A poorly understood topic, viscerosomatic pain is especially important to me as an osteopath as it can be dangerous in situations where it isn’t investigated as soon as possible—lives may literally be saved with better understanding of it.
I want to educate as many of my patients as I can in the hope that you can improve your health, understand pain better and seek medical attention. I’d like you to be able to warn your spouse, mother, father, grandparent, neighbour or colleague if they appear to be suffering from this type of pain to seek appropriate medical advice.
Viscerosomatic pain is referred pain from an organ within the body. Organs do not have as many pain (nociceptive) nerve fibers as muscles, joints, ligaments or other tissues of the body. When inflammation, tissue degeneration, blockage, bleeding or other injury is sustained to an organ, pain tends to be carried by other structures nearby that do have pain fibers (Vernon and Kasi, 2019).
Another factor to consider is that viscerosomatic pain will be experienced with pain from the autonomic nervous system.
Stay with me while I explain this.
The autonomic nervous system is made up of your ‘fight or flight’ (sympathetic) and ‘rest and digest’ (parasympathetic) nervous system divisions. These are responsible for several of their own homeostatic mechanisms (keeping the body within special, particular parameters for survival).
The organs in our bodies require supply from these divisions to keep a tight control over their functions. When there is a problem with an organ, the fight or flight(sympathetic) nerve fibres supplying it are activated as danger/threat to the organ is present. The sympathetic system will produce symptoms like those we experience when nervous or in trouble. Sweating, paler skin colour, increased heart rate etc. The sympathetic nervous system fibres are housed from T1–12 (all along the thoracic spine, right next to it in little bundles either side). The levels that give some fibres to the organ in question will become irritated with time as well.
For instance, inflammation of the gall bladder will produce right-sided shoulder pain. Other symptoms such as nausea, vomiting and lethargy may also be experienced by the person. But, often, the right shoulder pain is not connected with these symptoms. A primary health care practitioner is trained to look for these symptoms. The right-sided shoulder pain is caused by irritation of the nearby right phrenic nerve which supplies the diaphragm (the gall bladder sits very close by). This gives vague, diffuse and unspecific right shoulder and upper trapezius area pain. The duct of the gallbladder has its own sensory supply and can produce pain in the upper part of the abdomen, just beneath the sternum. Sympathetic supply comes from T7–9 (7ththoracic level to 9th) – on the right side. So, increased muscle tone, sweating and tenderness may be experienced in that area on the right (Beal, 1985).
Are you getting the idea of how such pain can be so easily misinterpreted and misdiagnosed?
Viscerosomatic pain may be likely with one of the following factors:
· hard to find, non-specific pain that is deep, dull and unrelieved by position changes
· skin texture change (sweaty, dry, red or blanched)
· skin hypersensitivity (very tender to touch) and parasthesia (numbness, change in sensation)
· muscle rigidity and spasm
· pain which has no obvious pattern (better/worse in morning or night, better/worse after activity or rest)
· chronicity (3+ months duration with little change)
· previous medical history of gastrointestinal, liver and lung disorders/infections (Your Health Matters, 2019).
The following image demonstrates where pain may be experienced in the body with relation to different organs
If you think you may be suffering from viscerosomatic-type pain, do not hesitate to make an appointment with your general practitioner for further investigation and a clinical opinion.
REFERENCES
Alvarez D.J. et al, Trigger points: Diagnosis and Management, Am Fam Physician, 2002, 15, 65, p. 653-660.
Arendt-Nielsen L, Svensson P (2001). ‘Referred muscle pain: basic and clinical findings’. Clin J Pain 17 (1): 11–9.
Beal, M.C, Viscersomatic reflexes: A review, Journal of AOA, Vol 85, (1985) (12), 786/53 – 801-68
https://yourhealthmatters.com.au/what-is-viscerosomatic-pain/, Accessed 10/9/19
Vernon H, Kasi A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 16, 2019. Anatomy, Abdomen and Pelvis, Liver.
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