CLINICAL ASPECTS OF DIAGNOSTICS OF REFERRED SOMATIC PAIN
https://doi.org/10.52485/19986173_2026_2_175
Abstract
The article analyzes the theoretical and experimental issues of referred somatic pain. To objectify the reflected pain syndrome, the use of the pain mapping method is justified.
Keywords
About the Authors
E. M. VishnyakovaRussian Federation
Elena M. Vishnyakova, Candidate of Medical Sciences, Associate Professor of the Department of Neurology, Neurosurgery and Medical Genetics
39a Gorky St., Chita, Russia, 672000
V. A. Shirokov
Russian Federation
Vasily A. Shirokov, Doctor of Medical Sciences, Professor, Scientific director of the Institute of General and Occupational Pathology
2 Semashko St., Mytishchi, Moscow Region, Russia, 141014
References
1. Treede R.D., Rief W., Barke A., Aziz Q., Bennett M.I., Benoliel R., et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019 Jan. 160 (1). 19–27. doi: 10.1097/j.pain.0000000000001384.
2. International Association for the Study of Pain (IASP). Recommendations for Pain Treatment Services. Access on 14 March. 2011. http://www.iasppain.org/AM/Template.cfm?Section=Pain_Treatment_Facilities.
3. Slipman C.W., Plastaras C.T., Palmitier R.A., Huston C.W., Sterenfeld E.B. Symptom Provocation of Fluoroscopically Guided Cervical Nerve Root Stimulation. Spine. 1998 Oct. 23 (20). 2235–42. doi: 10.1097/00007632-199810150-00019.
4. Hutson M., Ward A. Oxford Textbook of Musculoskeletal Medicine. Oxford: Oxford University Press. 2015. doi: 10.1093/med/9780199674107.001.0001.
5. Jin Q., Chang Y., Lu C., Chen L., Wang Y. Referred pain: characteristics, possible mechanisms, and clinical management. Frontiers in Neurology. 2023 Jun. 28. 14. 1104817. doi: 10.3389/fneur.2023.1104817.
6. Graven-Nielsen T., Arendt-Nielsen L. Musculoskeletal Pain: Basic Mechanisms & Implications. Washington. IASP PRESS. 2015. 546 p.
7. Stroman P.W., Ioachim G., Powers J.M., Staud R., Pukall C. Pain processing in the human brainstem and spinal cord before, during, and after the application of noxious heat stimuli. Pain. 2018. 159. 2012–2020. doi: 10.1097/j.pain.0000000000001302.
8. Hoheisel U., Mense S., Simons D.G., Yu X.M. Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Neuroscience Letters. 1993 Apr. 153 (1). 9–12. doi: 10.1016/0304-3940(93)90064-r.
9. Bannister K., Dickenson A.H. The plasticity of descending controls in pain: translational probing. The Journal of Physiology. 2017 May. 26. 595 (13). 4159–66. doi: 10.1113/jp274165.
10. Graven‐Nielsen T. Fundamentals of muscle pain, referred pain, and deep tissue hyperalgesia. Scandinavian Journal of Rheumatology. 2006 Jan. 35 (sup 122). 1–43. doi: 10.1080/03009740600865980.
11. Murphy D.R., Hurwitz E.L., Gerrard J.K., Clary R. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome? Chiropractic &. Osteopathy. 2009 Sep. 21. 17 (1). doi: 10.1186/1746-1340-17-9.
12. Bove G.M., Light A.R. The nervi nervorum. Pain Forum. 1997. Sep. 6 (3). 181–90. doi: 10.1016/s1082- 3174(97)70011-4.
13. Sterling P. Referred cutaneous sensation. Experimental Neurology. 1973. Nov. 41 (2). 451–6. doi: 10.1016/0014-4886(73)90287-2.
14. Rivers W.H., Head H. A human experiment in nerve division. 1908. Brain 31. 323–450.
15. Schmaedeke A.C., Erthal F.S., Vargas C.D., Ramalho B.L. Mapping referred sensation in traumatic brachial plexus injury patients. medRxiv 2024.02.19.23297564. doi: 10.1101/2024.02.19.23297564.
16. Pourrier S.D. et al. Three cases of referred sensation in traumatic nerve injury of the hand: implications for understanding central nervous system reorganization. 2010. Journal of Rehabilitation Medicine. 42. 4 (Feb. 2010). 357–361. doi: 10.2340/16501977-0526.
17. Myers T. Anatomy Trains: Myofascial Meridians for Manual Therapists and Movement Professional. 4th ed. New York. Elsevier. 2020.
18. Graven-Nielsen T. Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain. 2022 May. 15. 163 (S1). S29–45. doi: 10.1097/j.pain.0000000000002690.
19. Hockaday J.M., Whitty C.W.M. Patterns of referred pain in the normal subject. Brain. 1967. 90 (3). 481– 96. doi: 10.1093/brain/90.3.481.
20. Leoni D., Falla D., Heitz C., et al. Test-retest Reliability in Reporting the Pain Induced by a Pain Provocation Test: Further Validation of a Novel Approach for Pain Drawing Acquisition and Analysis. Pain Practice. 2017. 17 (2). 176–184. doi: 10.1111/papr.12429.
21. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009 Dec. 147 (1). 17–9. doi: 10.1016/j.pain.2009.08.020.
22. Harman J.B. Localization of Deep Pain. British Medical Journal. 1948 Jan. 31. 1 (4543). 188–92. doi: 10.1136/bmj.1.4543.188.
23. Laursen R.J., Graven-Nielsen T., Jensen T.S., Arendt-Nielsen L. The effect of compression and regional anaesthetic block on referred pain intensity in humans. Pain. 1999 Mar. 1. 80 (1). 257–63. doi: 10.1016/s0304-3959(98)00214-0.
24. Whitty C.W.M., Willison R.G. Some aspects of referred pain. The Lancet. 1958 Aug. 272 (7040). 226–31. doi: 10.1016/s0140-6736(58)90058-8.
25. Merskey H.., Bogduk N. Classification of Chronic Pain. Seattle. IASPPress. 1994. 94–95.
26. Fernández-de-las-Peñas C., Dommerholt J. International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain Medicine. 2017 Aug. 22. 19 (1). 142– 50. doi: 10.1093/pm/pnx207.
27. Maigne R. Douleurs d'origine vertébrale et traitements par manipulations. Expansion scientifique. 1968. 481.
28. Schott G.D. The cartography of pain: the evolving contribution of pain maps. European Journal of Pain. 2010 Sep. 14 (8). 784–91. doi: 10.1016/j.ejpain.2009.12.005.
29. Eboigbe U.D., Lawan A., Rushton A., Walton D.M. Types, method, and mode of implementation of pain/symptom maps in musculoskeletal pain rehabilitation: A scoping review protocol. Nik Ab. Rahman NH., editor. PLOS ONE. 2025 Mar. 18. 20 (3). e0319498. doi: 10.1371/journal.pone.0319498.
30. Amoruso E., Terhune D.B., Kromm M., Kirker S., Muret D., Makin T.R. Reassessing referral of touch following peripheral deafferentation: The role of contextual bias. Cortex. 2023 Oct. 167. 167–177. doi: 10.1016/j.cortex.2023.04.019.
31. Sankaran R., Kumar A., Parasuram H. Role of Artificial Intelligence and Machine Learning in the prediction of the pain: A scoping systematic review. Proceedings of the Institution of Mechanical Engineers., Part H: Journal of Engineering in Medicine. 2022 Sep. 23. 236 (10). 1478–91. doi: 10.1177/09544119221122012.
32. Dixit A., Lee M. Quantification of Digital Body Maps for Pain: Development and Application of an Algorithm for Generating Pain Frequency Maps. JMIR Formative Research. 2022 Jun. 24. 6 (6). e36687. doi: 10.2196/36687.
33. Ballantyne J.C., Fishman S.M., Rathmell J.P. Bonica's Management of Pain. 5th ed. Philadelphia. LWW. 2018.
34. Gadet Ph. Segmental innervation: a graphic synthesis of correspondence between dermatomes, myotomes, sclerotomes and viscerotomes. Systematic review of existing works and publications about dermatomes, myotomes, sclerotomes and viscerotomes aimed to design a graphic synthesis of somato- visceral correspondences. Russian Osteopathic Journal. 2019. 3–4 (46–47). 150–163. in Russian. doi: 10.32885/2220-0975-2019-3-4-150-163.
35. Rohde J. Neue-Untersuchungsmethoden der Tiefensensibilität am tastbaren Periost der Extremitäten bei Radikulärsyndromen. Manuelle Medizin. 2009. 47. 442–448. doi: 10.1007/s00337-009-0720-z.
36. Vishnyakova E.M, Shirokov V.A. Sclerotom and sclerotomic pain – actualization of the problem. Transbaikalian Medical Bulletin. 2022. (4). 79–89. in Russian. doi: 10.52485/19986173_2022_4_79.
37. Willis W.D Jr. The pain system. The neural basis of nociceptive transmission in the mammalian nervous system. Pain Headache. 1985. 8. 1–346.
38. Sherrington C.S. The Integrative Action of the Nervous System. New Haven. Yale University Press; 1926. 439 p.
39. Bogduk N. The physiology of deep somatic pain. Australasian Musculoskeletal Medicine. 2002. 7. 6–15.
40. Palsson T.S., Doménech‐García V., Boudreau S.S., Graven‐Nielsen T. Pain referral area is reduced by remote pain. European Journal of Pain. 2021 Jun. 3. 25 (8). 1804–14. doi: 10.1002/ejp.1792.
41. Steinbrocker O., Isenberg S.A., Silver M., Neustadt D., Kuhn P., Schittone M. Observations on pain produced by injection of hypertonic saline into muscles and other supportive tissues. Journal of Clinical Investigation. 1953 Oct. 1. 32(10). 1045–51. doi: 10.1172/jci102815.
42. Kellgren J.H. Observations on referred pain arising from muscle. Clinical Science. 1938. 3. 175–90.
43. McCall I.W., Park W.M., O'Brien J.P. Induced pain referral from posterior lumbar elements in normal subjects. Spine (Philadelphia Pa 1976). 1979. 4 (5). 441–446. doi: 10.1097/00007632-197909000-00009.
44. Sörensen J., Graven-Nielsen T., Henriksson K.G., Bengtsson M., Arendt-Nielsen L. Hyperexcitability in fibromyalgia. The Journal of Rheumatology. 1998. 25. 152–5.
45. Graven-Nielsen T., Kendall S.A., Henriksson K.G., Bengtsson M., Sörensen J., Johnson A., Gerdle B., Arendt-Nielsen L. Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain. 2000. 85. 483–91. doi: 10.1016/s0304-3959(99)00308-5.
46. Graven-Nielsen T., Arendt-Nielsen L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nature Reviews Rheumatology. 2010 Jul. 27. 6 (10). 599–606. doi: 10.1038/nrrheum.2010.107.
47. Chan C.W., Goldman S., llstrup D.M., Kunselman A.R., OʼNeill P.I. The Pain Drawing and Waddellʼs Nonorganic Physical Signs in Chronic Low-Back Pain. Spine. 1993 Oct. 18 (13). 1717–22. doi: 10.1097/00007632-199310000-00001.
48. Ranney Don M.D. A Proposed Neuroanatomical Basis of Waddell's Nonorganic Signs. American Journal of Physical Medicine & Rehabilitation. 2010 December. 89 (12). p 1036–1042. doi: 10.1097/phm.0b013e3181f70eae.
Review
For citations:
Vishnyakova E.M., Shirokov V.A. CLINICAL ASPECTS OF DIAGNOSTICS OF REFERRED SOMATIC PAIN. Transbaikalian Medical Bulletin. 2026;(2):175-187. (In Russ.) https://doi.org/10.52485/19986173_2026_2_175
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