Referred pain

Referred pain is felt in a part of the body different from the actual tissue causing the pain. Typically, the pain is initiated in a visceral organ or tissue and referred to an area of the body surface. Classic examples of referred pain include headache and angina. Interestingly, the brain does not contain noci-ceptors; therefore, pain perceived as a headache originates in other tissues, such as the eyes; sinuses; muscles of the head and neck; and meninges. Angina, or chest pain, is caused by coronary ischemia. It may be accompanied by pain referred to the neck, left shoulder, and left arm.

Referred pain most likely results from the convergence of visceral and somatic afferent fibers on the same second-order neurons in the dorsal horn of the spinal cord (see Figure 8.3). Therefore, the brain has no way of identifying the original source of the pain. Because superficial inputs normally predominate over visceral inputs, higher centers may incorrectly attribute the pain to the skin instead of the deeper tissue.

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