deep somatic pain

Examples of deep somatic pain in the following topics:

• Localization of Pain

  • Localization of pain is determined by whether the pain is superficial somatic, visceral, or deep somatic.
  • Nociceptive pain may also be divided into visceral, deep somatic, and superficial somatic pain.
  • It may be accompanied by nausea and vomiting and may be described as sickening, deep, squeezing, and dull.
  • Deep somatic pain is initiated by the stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae, and muscles, and is a dull, aching, poorly localized pain.
  • Examples of injuries that produce superficial somatic pain include minor wounds and minor (first degree) burns.

• Pain Sensation

  • Pain comes in two phases.
  • Nociceptive pain can be divided into visceral, deep somatic and superficial somatic pain.
  • It may be accompanied by nausea and vomiting and may be described as sickening, deep, squeezing, and dull.
  • Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is a dull, aching, poorly localized pain.
  • Examples of injuries that produce superficial somatic pain include minor wounds and minor (first degree) burns.

• Autonomic Reflexes

  • In these cases, the body will interpret the afferent pain stimulus as somatic.
  • While the unconscious reflex arcs are normally undetectable, in certain instances they may send pain sensations to the CNS, masked as referred pain.
  • If the peritoneal cavity becomes inflamed or if the bowel is suddenly distended, the body will interpret the afferent pain stimulus as somatic in origin.
  • This pain is usually non-localized.
  • This schematic (but not anatomically correct) depiction of a typical spinal nerve indicates (1) somatic efferent fibers, (2) somatic afferent fibers, (3 to 5) sympathetic efferent fibers, and (6 and 7) sympathetic afferent fibers.

• Somatic Sensory Pathways to the Cerebellum

  • Commonly recognized sensory systems are those for vision, hearing, somatic sensation (touch), taste, and olfaction (smell).
  • Once in the deep, white matter of the cerebellum, the axons recross the midline, give off collaterals to the globose and emboliform nuclei (deep cerebellar nuclei), and terminate in the cortex of the anterior lobe and vermis of the posterior lobe.

• Sensory Modalities

  • Proprioception and touch are related in subtle ways, and their impairment results in deep and surprising deficits in perception and action.
  • Nociception (physiological pain) signals nerve or other tissue damage.
  • The three types of pain receptors are cutaneous (skin), somatic (joints and bones), and visceral (body organs).
  • It was previously believed that pain was simply the overloading of pressure receptors, but research in the first half of the 20th century showed that pain is a distinct phenomenon that intertwines with all of the other senses, including touch.

• Pons

  • The alar plate produces sensory neuroblasts, which will give rise to the solitary nucleus and its special visceral afferent column, the cochlear and vestibular nuclei (which form the special somatic afferent fibers of the vestibulocochlear nerve), the spinal and principal trigeminal nerve nuclei (which form the general somatic afferent column of the trigeminal nerve), and the pontine nuclei, which is involved in motor activity.
  • Basal plate neuroblasts give rise to the abducens nucleus (forms the general somatic efferent fibers), the facial and motor trigeminal nuclei (form the special visceral efferent column), and the superior salivatory nucleus, which forms the general visceral efferent fibers of the facial nerve.
  • The functions of the four nerves of the pons include sensory roles in hearing, equilibrium, taste, and facial sensations such as touch and pain.

• Injuries to the Phrenic Nerves

  • Pain arising from structures served by the phrenic nerve is often "referred" to other somatic regions served by spinal nerves C3-C5.
  • For example, a subphrenic abscess beneath the right diaphragm might cause a patient to feel pain in the right shoulder (Kehr's sign).

• Somatic Sensory Pathways

  • In the case of touch and certain types of pain, the third neuron has its cell body in the ventral posterior nucleus of the thalamus and ends in the postcentral gyrus of the parietal lobe.
  • In the periphery, the somatosensory system detects various stimuli by sensory receptors, such as by mechanoreceptors for tactile sensation and nociceptors for pain sensation.
  • The sensory information (touch, pain, temperature, etc.,) is then conveyed to the central nervous system by afferent neurons, of which there are a number of different types with varying size, structure, and properties.
  • For example, slow, thin, unmyelinated neurons conduct pain whereas faster, thicker, myelinated neurons conduct casual touch.

• Intercostal Nerves

  • The intercostal nerves are part of the somatic nervous system and arise from anterior divisions (rami anteriores, ventral divisions) of the thoracic spinal nerves T1 to T11.
  • Unlike the nerves from the autonomic nervous system that innervate the visceral pleura of the thoracic cavity, the intercostal nerves arise from the somatic nervous system.
  • This explains why damage to the internal wall of the thoracic cavity can be felt as a sharp pain localized in the injured region.

• Appendicitis

  • Pain first, vomiting next, and fever last has been described as the classic presentation of acute appendicitis.
  • Since the innervation of the appendix enters the spinal cord at the level T10, the same level as the umbilicus (belly button), the pain begins mid-abdomen.
  • This pain can be elicited through various signs and can be severe.
  • Also, there is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness).
  • Coughing causes point tenderness in this area and is the least painful way to localize the inflamed appendix.