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The Pain Page

 

Pain is an adaptive response to dysfunction, therefore, prior to experiencing pain an individual experiences dysfunction of either the musculoskeletal system (somatic), viscera, or psyche. Over the years, there have been numerous physiological models advanced to explain the mechanisms of pain. We have attempted to employ commonality of thought as it pertains to mainstream medicine and leading authors on the subject of pain. Regardless of the model, all pain involves nerve supply, whether or not, its referral is related to trigger points, reflex pain from diseased viscus, or exclusively related to the nerves. Nerve pain, or its counter part, loss of sensation, is usually described as sharp or lancinating, electrical or knife-like, numb or tingling. Throbbing pain is usually vascular in origin. Trigger point pain is usually described as deep, aching, or burning. However there is certain trigger points, which can produce sharp pain such as, found in the Quadratus lumborum, or in the case of the Platysmas, numbness and tingling (paresthesia) may be exhibited.

Using shoulder pain as an example, the reader should note, that there may appear to be discrepancies between nerve supply and dermatome patterns. Spinal nerves C4 and C5 supply the Rhomboids and the Scalenes, yet, the dermatome referral pattern for a C4 or C5 radiculopathy references the back of the neck and the top of the shoulders. However, when that spinal nerve supply for whatever reason becomes dysfunctional, the muscles that are also supplied may develop trigger points and its deep aching referral pattern to the medial aspect of the shoulder blade. Therefore, a practitioner, when viewing nerve innervation, must not only look at the pain referral area but also establish all the muscles which potentially could contribute to trigger point referral which could skew their findings based upon the subjective report of pain. Diseased viscus or organs may also cause atypical pain referral. This is attributed to the embryonic development of tissue prior to differentiation, as the fetus matures. This seems to be the most recognized reason that individuals, whom are experiencing a tubal pregnancy or prostate cancer, would experience shoulder pain, as referenced above. Therefore, if you exclusively use our dermatome charts, that shoulder pain will be caused by a radiculopathy at C7, T1, or T2. If you exclusively use the trigger point charts, that shoulder blade pain may be caused by the Rhomboids, or the Scalenes, among others. As the Scalenes and Rhomboids are both innervated by the Dorsal scapular nerve, which branch off from spinal nerves C4 and C5, wouldn’t a radiculopathy at that level also be possible? There is no substitute for a comprehensive knowledge base, therefore, when reviewing this material you must consider dermatome patterns, trigger point referral patterns, and the possibility of reflex pain from a visceral disease. For those that are non-physicians this is intended to provide you with an overview of the complexities of pain management. You should note, that frequently it requires elaborate diagnostics established through laboratory and instrumentation, to determine the cause of pain. And without a physical examination and diagnostic testing, the reader may only infer that this is scientific food for thought, but certainly cannot be solely established to develop a course of treatment. We have attempted to put things on our home page so that a quick reference may be employed, however for specificity, the search capability is necessary.

 

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