feinstein langton j n k jameson r m (1 Ergebnisse)

J. Bone Jt. Surg., 36-A/5. - Boston 1954, 8°, pp.981-997, 63 Fogs., orig. wrappers. Offprint! From the Departments of Anatomy and Neurology, School of Medicine, University of California, San Francisco. "Pain provoked by the irritation of tissues deep to the skin has a characteristic quality and tends to be diffusely "referred". Unlike acute pain from the skin, it persists for a considerable period of time, is rather slowly transmitted to the consciousness, and is often associated with autonomic or other "reflex" concomitants, such as bradycardia, a fall in the blood pressure, nausea, and skeletal muscle spasm. Although the radiating nature of deep pain has always been of theoretical and clinical interest, it has been experimentally investigated in muscle only since Lewis and Kellgren used the method of injecting hypertonic saline. Kellgren mapped the segmental areas of deep pain and tenderness below the fourth cervical vertebra by systematically stimulating the "interspinous ligaments" of three subjects. His technique was used by Campbell and Parsons to produce referred pain from the upper cervical "somites". Inman and Saunders studied the relation of experimentally induced pain to clinical problems of deep pain and introduced the concept of "sclerotomes". These studies have received only scanty critical consideration. It also still seems to be frequently taken for granted that the segmental distribution of deep pain follows the familiar dermatomes. Little attention, moreover, has been paid to the autonomic and affective concomitants which are characteristic of pain in deep tissue. A systematic study of the patterns of pain which follow the stimulation of paravertebral and limb muscles was, therefore, carried out. The number of subjects used was larger than that investigated in Kellgren's work, and the upper cervical segments were included. In addition, observations were made on such concomitant phenomena as the autonomic repercussions and the cutaneous sensory changes in the skin overlying areas of deep pain, and on the influence of somatic and sympathetic-nerve block." Feinstein, et al.