Referred Muscle Pain and Hyperalgesia from Viscera

Maria Adele Giamberardino, Giannapia Affaitati, Sabina Iezzi, L Vecchiet
In: Journal of Musculoskeletal Pain · 1999 · vol. 7(1-2) , pp. 61–69 · doi:10.1300/j094v07n01_07 · W1985147246
article OA: closed CC0 ⤵ 1 in-corpus citation
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Visceral pain commonly causes secondary hyperalgesia and trophic changes in referred somatic muscle, likely due to central sensitization or peripheral reflex arcs activating nociceptors.

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Abstract

SUMMARYThe process of pain referral applies constantly to algogenic diseases of internal organs. In the somatic areas of referred pain from viscera, usually located within the metameric field, secondary hyperalgesia [increased sensitivity to pain, decreased pain threshold] most often arises at muscle level. In patients with different diseases of internal organs [gastrointestinal and urinary tracts, female reproductive organs] this hyperalgesia, as evaluated via pain threshold measurement, proved to be an early process, proportional in extent to number and intensity of visceral pain episodes and prolonged in duration [i.e., long outlasting the spontaneous pain]. Together with hyperalgesia, muscles in the areas of pain referral often present trophic changes, i.e., decreased thickness and section area documented by ultrasounds.Referred muscle pain and hyperalgesia from viscera are normally attributed to processes of central sensitization which, as shown by electrophysiological studies on animal models of this condition, take place in the central nervous system, triggered by the massive afferent visceral barrage upon convergent viscero-somatic neurons. The visceral barrage, however, could also activate a reflex arc towards the periphery [afferent branch: visceral afferent fibers, efferent branch: sympathetic and/or somatic efferences] resulting in sensitization of nociceptors and trophic changes in the somatic area of referral.

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