Referred Pain

Or, The Connections of Pain Transfer

Disease symptoms and their causal structure are occasionally far apart. The why and how is the subject of the following article and is explained in more detail in two case histories. Within a therapeutic practice the most diverse symptoms or symptom complexes are often treated successfully directly “on the spot”. Occasionally however well-intentioned and well-proven therapies remain without a “happy ending”. Why? Of course one endeavors to explain the individuality of the patients and their specific life situations. I regard this perception as unsatisfactory, especially since the consideration of Referred Pain (transferred pains) often helps us further and then the affected patient can nevertheless still be treated successfully, e.g. with Osteopathy and/or Photon-Magnetic Field Therapy

Referred Pain or transferred pain (projection pain) describes pain sensations and other discomforts which are caused by the internal organs but which partially show in areas far away on the body surface (skin, musculature, bones). Besides, the triggering organ can still be clinically silent. On the one hand this phenomenon takes place over fascial connections and on the other hand through neuronal interconnections. The last-mentioned can be explained among other things as follows:

Visceral and somatic pain stimuli released by irritated nociceptors as well as a multitude of mechanoreceptor stimulations (skin, muscles, capsules, ligaments) of some segments are conducted to the side- and posterior- horns of the spinal cord before they are collected by the WDR cells (wide dynamic range cells) in the posterior spinal horn, and then are conducted over ascending spinal cord pathways to the primary-sensory-cortex (PSC / homunculus). The PSC cannot differentiate whether the incoming irritation stimulus goes back to the skin, vessels, muscles or viscera. However because the skin is very prominently represented in the homunculus in comparison with the viscera, e.g. a pain stimulus is projected (Referred Pain) – according to the law of probability – into the segmental dermatome C8-Th5, although the heart does not feel well.

Following is described how the symptom complex of two supposed therapy failures were resolved under consideration of a diagnosed Referred Pain within three treatment appointments with the combination of ProLight Photon Therapy (description below) and Osteopathy.

Case 1

Mr. S. 79 years old appeared for the first time in my natural healing [naturopathic*] practice five years ago.

Before his upcoming shoulder operation, right in ten days, he had bad misgivings because no serious pathological processes could be shown in either the x-ray or in the MRT. The treating orthopedist believed he must now take a close look at the structure by arthroscopy, and then he could say more or directly intervene curatively. Thereupon an old school friend advised Mr. S. to obtain a second opinion.

Thus Mr. S. came to my practice and reported during the first consultation that for many years now he particularly suffers from changeable shoulder pains. Through specific enquiries I found out that the occurring pain condition appears rather vaguely and also in the nape of the neck, in the clavicle area as well as partially up into the right arm. Furthermore he added, that for some time it stands out for him, that often the right shoulder girdle appeared to be cold and draft sensitive. Also he sometimes senses a strange “trickle away shiver” in the shoulder-nape area.

Further characteristics of the anamnesis, inspection and palpation resulted in:

• Partial headaches in the temporal / parietal area, right (for years)
• Mydriasis (dilated pupils), right, as well as pulling up on the right corner of the mouth
• Diaphragm raised high, right, with alternate singultus (hiccup)
• Ideopathic blood pressure fluctuations for approximately two years
• Vasoconstrictions in the right shoulder-nape area as well as in the right body quadrant
• Pressure-painful spinous processes (Th6-9) in group lesion
• Hyperalgesic dermatome (Head’s Zones) and myotome (Mackenzie Zones**), caudal, on the right caudal arch (Th8-Th11)
• Pressure-painful costal arch as well as ribs 11 + 12 (sclerotome), right
• Hyperesthesia and hyperalgesia lateral lower legs and ankles, right
• Paresthesia in the ventro-lateral thigh
• Chronic Hepatitis B (mild to unapparent course without hepatomegaly for many years)
• Changeable stools

When first glancing over the gathered information, the impression of a “jumbled symptom heap” could develop.

With intensive study however it stands out that it is about valuable mosaic stones which indicate understandable illness events outgoing from the liver.

The first suspicion of the liver was confirmed through a visceral osteopathy “Local-Listening” [screening test], a liver mobility test and the Sotto-Hall Test (see Barral¹ and Hebgen⁶).

With Local Listening a hand inner surface with its net weight is laid centered on the abdomen. Provided that you feel a fascial feature, you follow this. The travel direction shows the place of the restriction. In tendency I was pulled into the upper right quadrant. For example scars, adhesive bands or adhesions (e.g. from inflammation processes) can be causal for the restrictions.

To further confirm my findings the liver mobility test follows next for all three movement axes: He shows a tendency to organ fixation with limited organ movements in all levels.

Last but not least follows the Sotto-Hall Test for final validation:

In this case I check indirectly whether the liver has relevant influence on the pathological shoulder structure as I inspect the radial pulse while bringing the A. subclavia fascia into distress.

After I feel the radial pulse clearly under my fingers, the bent arm of the patient is brought into abduction, retroversion and outside rotation. The patient rotates his head to the other side. Thereby the thoraco-fascial system is brought under tension. If the radial pulse becomes markedly weaker or it vanishes fully, the test is positive. The organ fixation / osteopathic dysfunction brings a pathological tensions across the fascial chain up to the upper thoracic aperture / Fossa supraclavicularis major, by which the A. subclavia gets into distress and the pulse is affected.

If the fascial chain is relaxed afterwards by raising the liver and the full pulse then comes back, the liver has a decisive part in the discomforts in the shoulder-arm area over the connecting fascia.

All tests proceeded positively with Mr. S.

But moreover, the liver can also be jointly responsible for the shoulder across the neuronal interconnections and completely alone can be responsible for all the other further above mentioned symptoms. Besides, we must think of the following anatomical connections:

• The liver is parasympathetic efferent*** innervated from the vagus (stimulates glycogen formation). Sympathetic efferences come to the thoracic spinal column segments Th5-9 (literature data varies here, stimulates glycogenolysis).
• On the one hand the liver afferences reach across the parasympathetic part of the phrenicus (also leads afferences from the costal pleura, the pericardial sac and the parietal peritoneum) across the cervical spinal column (C3-5) to the central nervous system (CNS). On the other hand the sympathetic afferences of the liver reach across the sympathetic trunk to the segments Th8-10/11 ({Mackenzie zones}, Th5-9, Netter¹⁰ among others) and further across collaterals to the lumbar plexus (Th12-L4) as well as to the ciliospinal center (C8-Th3).
• Nevertheless, some highly interesting diagnostic and therapeutic interconnections come which will further solve our case.
• The phrenicus for instance undergoes an interconnection at the level of C4/5 with the brachial plexus (C5-Th1), from here innervates the skin at the shoulder level and upper arm as well as the musculature of the shoulder girdle. Therefore, with upper abdomen or thoracic illnesses – next to painful Head’s zones in the dermatomes, myotomes and sclerotomes of the body – they can come to shoulder pains (all Referred Pain).
• The phrenicus projects into the cervical spinal column area virtually into “its” segments.

Moreover the N. phrenicus maintains an indirect connection to the ganglion stellatum¹ and to the N. vagus. Alongside a hyperalgesia a sympathicotonic reaction in the skin and its accessory structures also originates through the sympathetic influence. A vasoconstriction (vasomotoric) of an intensified sweat secretion (sudomotoric) is often described by the affected patient as cold and draft sensitivity. A bristling tendency of the hair in the shoulder region (pilomotoric) is felt by patients as a “trickle away shiver” and in addition to inspection it rather stands out with hairy patients.

At the level of the second cervical vertebra the Vagus delivers afferent fibers to the segment C2/3. Sympathetic afferences reach across the sympathetic trunk outgoing from the ciliospinal center (vegetative center of the spinal cord, at level C8-Th3), likewise to the segment C2/3 (network of A. carotis interna), where virtually all impulses meet and the tomes (derma-, myo-, sclerotome) are passed on. Thereby any applicable head and shoulder-nape pains can be explained. Also the right-sided mydriasis occurs as vegetative-reflex projection signals outgoing from the ciliospinal center. In addition, the vegetative-reflex induces the raised level of the corner of the mouth as a mimic [of facial expression] tension as well as painful areas in the costal arch, ribs 11 + 12 as well as the thoracic vertebral spine 6-8.

However the interconnections are not enough. At the level of the Medulla oblongata we find yet another of the N. vagus with the Nucleus spinalis nervi trigemini which of course also sometimes passes on the impulses of the internal organs (e.g. jaw pains, toothaches and headaches with heart problems).

On the other hand the right-sided raised level of the diaphragm with occasional singultus is connected with the transmission of the viscero-motoric phrenicus reflexes (viscero-afferent neurons reaching across collateral motoric anterior horn cells [of the spinal cord]). (Note: Defense of the abdominal wall with inflammatory processes of the abdominal organs also occurs in this way.)

The elevated blood pressure as well as the leg pains still remain to be explained.

All internal organs of the segment area C8-Th7 can be about viscero-visceral reflex triggers of tachyarrhythmia and blood pressure changes, because precisely this segment area is innervated by the heart.

Alongside the many liver projections in the upper body regions the possibility of Referred Pains in the lower extremities through transmission of the sympathetic stimuli also very much exist.

Moreover afferent impulses of the segments Th8-11 are conducted across collaterals in the sympathetic trunk to the Plexus lumbalis (Th12-L4) and further into the N. femoralis (L1-4) as well as partially also N. peroneus (L4-S2). Thus, no wonder that Mr. S. also complained about discomforts in his right leg. After being informed by the patient and through the physical examination the matching discovered mosaic pieces are joined together, and the therapy can begin in connection.

In my natural healing [naturopathic] practice I like to combine the ProLight-Photon-Magnetic Field Therapy with Osteopathy, in order to support the self healing forces at the energetic and physical levels equally. For Mr. S. both came into use successfully.

ProLight-Photon-Magnetic Field Therapy

As the first column of therapy – the ProLight-Photon-Magnetic Field Therapy has a regulating and thus a balancing effect on the biophysical level of the patient.

In this connection a special therapy device is used for about 45 minutes. It generates a magnetic field comparable to the earth’s magnetic field, however in a little higher strength and – at the same time – a polyfrequency and coherent light spectrum² which is related in the best possible way to sunlight.

Coherent light and the earth’s magnetic field represent a matrix in which material structures can be formed and through which living structures can be regenerated if necessary. Hence, living beings need these (possibly clean) fields as vital ordering and steering stimuli. In the case of illness – here a liver burden – the patient lacks urgent necessary information / frequencies / oscillations, in order to gain back the usual natural quality of life.

The application of the Photon-Magnetic Field device gives into a depth at the illuminated body area (here among other things the liver dermatome / Head’s zones) – among other things through a domino effect³ – an extensive wide frequency buffet which virtually all cells can access in order to regenerate as well as possible. At the same time it stands and works independently, so that my hands remain free for a simultaneous osteopathic treatment.

Osteopathy characteristically establishes direct or indirect contact with the body structures, which are weakened or are in some other way physiologically impaired in order to promote their regeneration. Of course it also indirectly affects the energetic structures of the patients. A cornerstone of osteopathic philosophy contains the statement:

The structure determines the function and vice versa.

A structural impairment was found diagnostically for Mr. S. both in the liver supporting apparatus as well as in the spinal column segments relevant to the liver. They react hyperactively to the afferent triggering from the liver with the result of a movement restriction.

With my patient I found a group lesion in the segments Th6-9.

With the help of structural Osteopathy to free these segments, i.e. to resolve their restrictions, it turned out very well.

At the viscero-osteopathic level the whole liver, the liver support apparatus, the sympathetic trunk and the Plexus coeliacus were treated, in order to remove the afferent irritations.

Moreover, by cranial-sacral-osteopathy the vegetative interaction had outstanding regulating influences which beneficially came to a conclusion for application of the treatment.

After the first treatment Mr. S. had already cancelled his Shoulder-Operation-Appointment. He still came twice more for the “Shoulder-Treatment” before all symptoms were resolved.

Since that time up to the present day I see Mr. S. once a month for general vitality support. His shoulder problem has not again appeared.

Case 2

Now in the same way the following more detailed – already announced above – second patient’s case is also based on an extremely interesting interweaving.

Mrs. Z. 43 years old, office administrator and mother of a 13 year old daughter, appeared in my practice with head, shoulder and back pains.

The pain symptoms had already reduced her quality of life for about 1¾ years. Nevertheless, the [symptoms] do not always appear together. Occasionally they are felt alternately or only latently-vaguely.

Previous therapies were in existence and consisted of taking painkillers, injections by the family doctor, massages and physiotherapy, however without noticeable improvement.

My further anamnesis , inspection and palpation proved:

• Headaches rather frontal-temporal and parietal
• Shoulder pains in the area of the shoulder girdle
• Back pains in the thoracic spinal column area up to the thoracolumbar transition and to the Crista iliaca
• Light paleness in the left facial half
• Sometimes unclear lower jaw pains and toothaches in the grinding tooth area
• Partial pains when swallowing
• Increased perspiration under left armpit
• Cold feeling in the left body half
• Constipation with meteorism as well as singultus (hiccups) and rare vomiting
• (Pressure) painful area in the caudal area of the pectoralis major (C5-Th1) (especially in the rib beginnings and sternum {Tietze’s syndrome}) as well as the caudal area of the M. latissimus dorsi (C6-8) in the iliac crest
• (Pressure) painful spinous process in the area of C7-Th3 with heightened vasodilation over the spinous process points.

[Osteopathic] Treatment combined with Pro-Light

With Mrs. Z. we again have to deal with many mosaic pieces that would like to be put together meaningfully.

Let’s remember:
Internal organs project their disturbances into the sympathetic and parasympathetic pathways and origin cells of their innervations and across various interconnections on the CNS level (indirectly homunculus) further into their organ specific dermatome, myotome, angiotome and sclerotome or on certain brain nerves (N. vagus to N. trigeminus).

In the present case of Mrs. Z. we find ourselves confronted with a left-sided symptomatology standing out. Therapies on the Loci dolendii [painful points] did not proceed successfully.

Taking the Referred Pains into account my first thoughts went in the direction of the heart or stomach. Both organs lie near the diaphragm and pass on their afferences across the N. vagus, N. sympathicus and N. phrenicus.

At the level of the Medulla oblongata the N. vagus is interconnected with the spinal nucleus of the trigeminus, which explains the headache, jaw pain and toothaches (“trigeminal cardiac reflex”, as there is also a “trigeminal pulmonary reflex”).

Besides, parasympathetic and sympathetic fibers have a connection to segment C2, with which the pains on swallowing are understandable.

The N. phrenicus has influence on segment C3-5 and on the other hand leads efferences to the diaphragm by which with irritation it can come to singultus. These segments (C3-5) are also partly involved in the innervations of the shoulder girdle.

The M. trapezius for instance moves with its three parts from the occiput to the thoracolumbar transition and besides the N. accessorius supplies to the segments C2-4. It can also project without further transmitted stimuli to the N. phrenicus as pains in the thoracic spinal column up to the thoracolumbar transition.

We find similar connections to the M. latissimus dorsi.

It extends with its four original parts among others from the Os sacrum and the Crista iliaca to the Crista tuberculi minoris of the upper arms. The innervation comes to the segments C6-8, and C8 takes over the supply of the lower part.

The segmental affiliation of the heart is generously assessed and extends from C8-Th7 (literature data partially varies) from which it can easily be taken and from which the pains of Mrs. Z. result on the left medio-lateral Ala of the ilium/small of the back.

The stomach is already ruled out at this point because it is associated segmentally to the areas of Th5-9. An interconnection at C8 does not occur here.

The vegetative reflex symptoms (vasoconstriction, left facial-half and increased axillary sweat secretion) can be deduced through the corresponding vegetative supply. Head and upper extremities receive their sympathetic innervations at the spinal cord segments C8-Th7 virtually in parallel with the heart.

Through the viscero-visceral reflexes the abdominal symptoms are understandable. They are often already developed at the beginning of a heart illness.

However the cause for the co-reacting healthy organs in the searched similar segmental supply has not yet been verified.

Painful areas in the lower Pectoralis major area are typically Head’s zones of the heart and explain the pressure painful spinous processes as another Referred Pain. According to Mackenzie the spinous processes C7-Th3 become pressure and pain sensitive at the first with a cardiac irritation. Often this observation goes along with a strengthened vasodilation of the spinous tips as well as a paravertebral swelling in the above mentioned segments.

In principle it remains to be recorded that as a rule internal organs communicate any early irritations to the body surface (dermatome, myotome and sclerotome) early, so that with timely therapeutic recognition and intervention serious pathologies can be prevented.

Perhaps it is for [the practitioner] who knows how to interpret the signs. In the present case I treated Mrs. Z. osteopathically during the first consultation as well as also with the help of the ProLight-Photon-Magnetic Field Therapy, and afterwards with the suspicion of the beginning cardiac insufficiency I recommended her to the cardiologist for further diagnostics.

Then in the second treatment I found out the cardiological diagnosis. She was: Beginning mitral valve insufficiency through ideopathic elongation of the Chordae tendineae.

A “certain” physical protection and a period of restriction from recreational drugs was advised on the part of the cardiologist, a regular controlling examination was recommended. Medications were not prescribed because Mrs. Z. still does not show any cardiological symptoms.

We continued the treatments in my practice and were able to considerably reduce the symptoms after two further consultations. Now they appear only sporadically and considerably milder than before.

At present I see Mrs. Z. every two or three months for supporting treatment.

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An Exclusive Article for OIRF Supporters
From THE BRIDGE Newsletter of OIRF
Published March 2014

From an article in Naturheilpraxis, Volume 66, August 2013 (8/2013)
Machine Translation by SYSTRAN, Lernout & Hauspie, LogoMedia & Promt
Translation & redaction by: Carolyn L. Winsor, OIRF

© Copyright 2013, Dr. Jörg V. Schöpe, Hattingen, Germany

Author Comments:

1. Through collateral formation in the sympathetic trunk, and phrenicus impulses of the stomach organs near the diaphragm are transmitted from the C3-5 in the spinal cord to the ciliospinal center (C8-Th3) and from there across the sympathetic fibers into the corresponding spinal nerves to the shoulder.
2. Only coherent light is able to transfer information.
3. The presented photon field information spectrum is perceived among other things at the cellular level and “handed on” through intercellular biophoton communication (microtubule, etc.).

Translator Notes:
* All words or phrases in italics and enclosed in square brackets [ … ] are added by the translator for clarification purposes only.
** The afferent pathways of some spinal nerves from the musculature are called Mackenzie Zones. They play a role with the phenomenon of pain transfer.
*** Note carefully the difference between afferent and efferent. Great care has been taken in translation to preserve the author’s meticulous references in this respect.

Literature:

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