Reffered Pain
Reffered Pain
Reffered Pain
Definition
The pain sensation produced in some parts of the body is felt in other structures away from the place of development. This is called referred pain. The deep pain and some visceral pain are referred to other areas.
Dermatomal rule: Pain is referred to a structure, which is developed from the same dermatome from which the pain producing structure is developed. A dermatome includes all the structures or parts of the body which are innervated by afferent nerve fibers of one dorsal root. For example, the heart and inner aspect of left arm originate from the same dermatome. So, the pain in heart is referred to left arm.
A dermatome is an area of the skin supplied by nerve fibers originating from a single dorsal nerve root. The dermatomes are named according to the spinal nerve which supplies them.
Myotomes - Relationship between the spinal nerve & muscle Dermatomes - Relationship between the spinal nerve & skin
Primary Pain
Pains in which the site and source are in the same location.
Heterotopic Pain
Pains in which the site and source are not in the same location.
Heterotopic Pain
Pain felt in an area other than its true site of origin (associated with deep, somatic pain).
Projected pain: perceived in the anatomic distribution of the same nerve that mediates the primary pain (painful adjacent teeth). Referred pain: felt in an area innervated by a different nerve from the one that mediates the primary pain (teeth in opposing arch, face, head, neck).
Cardiac pain is felt at the inner part of left arm and left shoulder. Pain in ovary is referred to umbilicus. Pain from testis is felt in abdomen. Pain in diaphragm is referred in right shoulder. Pain in gallbladder is referred to epigastric region. Renal pain is referred to loin.
Nonodontogenic Toothaches
Most toothaches will be of odontogenic origin. However, if there is no identifiable cause or source (e.g. caries) for the pain, or the history and clinical findings are inconsistent with odontogenic pain, then a nonodontogenic source should be considered.
Cardiac Toothache
Angina pectoris or acute myocardial infarction, refer pain to the shoulder, arm, the jaw and to the teeth. Associated with chest pain, but occasionally, it is not Tooth ache increases with exercises and decreased with medication specific for the heart (nitroglycerin) Treatment is directed to the underlying heart problem, after dental evaluation.
Periodic dull pressure of aching in the mandible or Clinical teeth; may accompany pain in chest or arm; history of Characteristics angina; pain precipitated by exercise, stress, or physical activity.
Nonpulsatile; constant, aching; variable and cyclic; Clinical pain increases with stress and use of offending Characteristics muscles.
Anesthetic block of tooth does not alter pain; anesthetic injection of trigger point relieves pain.
Treatment and elimination of trigger points by spray and stretch, injection, or physical therapy.
Constant dull ache or pressure; sensitivity to cold, Clinical percussion, chewing; pain in multiple teeth; pain Characteristics increased by bending body forward; sinus tender to palpation; Waters may show air-fluid level.
Topical anesthesia of nasal mucosa relieves pain in anterior teeth; infiltration anesthesia of posterior teeth relieves pain. Antibiotics, antihistamine with a decongestant, analgesic.
Unilateral, severe, paroxysmal bursts of electric-like Clinical shocks stimulated by minor superficial provocation; Characteristics may be felt in teeth; asymptomatic between episodes.
Local Anesthetics
Treatment
Topical anesthetic of mucosal or skin trigger blocks pain; anesthetic block of nerve root blocks pain. Referral to neurologist or neurosurgeon.
Constant pain with no obvious pathology; burning, Clinical aching pain in molar/premolar area longer than 4 Characteristics months; local provocation not reliably effect pain.
Local Anesthetics
Treatment
Equivocal response
Maxillay canines/premolars; no dental cause; Clinical throbbing, episodic, persistent, recurrent pain; dental Characteristics treatment may provide temporary relief; may become widespread.
Local Anesthetics
Treatment
Bizarre behavior; history of psychiatric treatment; Clinical migratory pain in multiple teeth, frequently bilateral; Characteristics unexpected or inappropriate response to treatment.
Equivocal effects.
Refer to psychiatrist.
Reffered Pain
Constant deep pain input can alter the central processing of nociception.
2. If another nerve is affected, it is usually cephalad to the nerve that mediates the pain.