[libribook.com] Traumatic Scar Tissue Management 1st Edition

Referred pain
Sensitization
Pain perceived at a location other than the site of the painful
stimulus/origin (e.g. referred pain associated with MTrPs). Referred pain
may thus occur in a region that is either remote from or directly
contiguous with the source of pain, but the two locations are
distinguishable on the basis of their different nerve supply. Pain can be
referred into the corresponding myotome, dermatome or sclerotome from
any somatic or visceral tissue innervated by a nerve root, but, confusingly,
sometimes it is not referred according to the commonly known pattern.
Referred pain is a common occurrence in problems associated with the
musculoskeletal system. Pain quality is usually described as deep and
aching and although its central locus is recognizable and constant, its
margins are hard to define (Kellgren 1938, 1939, Feinstein et al. 1954,
Magee 2008, IASP 2014)
Changes in the PNS or CNS (adaptive or pathologic) that lead to
heightened nociceptive responses and/or lower thresholds, i.e. a lower
intensity stimuli results in increased responsiveness. Clinically,
sensitization may only be inferred indirectly from presenting phenomena
such as hyperalgesia or allodynia, and may include dysfunction of
endogenous pain control systems:
• Central sensitization: increased responsiveness of nociceptive neurons in
the CNS
• Peripheral sensitization: increased responsiveness of nociceptive
neurons in the periphery