PAIN REFERRAL PATTERNS VISCERAL PAIN REFERRAL PATTERNS MECHANISM OF VISCERAL REFERRED PAIN     Neurology of visceral pain not understood at this time Afferent fibres known to run with the blood vessels along similar pathways to the SNS Viscerosensory fibres ascend to the thalamus and the project to several areas of the brain which encode for site Differentiation done poorly by brain due to      Low receptor density Large overlap in brain Multisegemental innervation Embryological development Direct Pressure (diaphram) ANATOMY REVIEW OESOPHAGUS PEPTIC & DUODENAL ULCER PANCREATITIS LIVER & GALLBLADDER Liver & Gallbladder UC & CHRON’S DISEASE CARDIO RESPIRATORY ANATOMY REVIEW BLUE BLOATER PINK PUFFER LUNG REFERRAL HEART PAIN REFERRAL Heart AAA ANGINA MYOCARDIAL INFARCTION PERICARDITIS UROGENITAL & GYNAECOLOGICAL ANATOMY REVIEW UROGENITAL REFERRAL Kidney , Urethral & Bladder GYNAECOLOGICAL REFERRAL ZYGAPOPHYSEAL REFERRAL PATTERNS CERVICAL FACET REFERRAL PATTERNS C2-3 C3-4 C4-5 C5-6 C6-7 Dwyer et al THORACIC FACET JOINT REFERRAL Dreyfuss et al T3-4 T4-5 T5-6 T6-7 T7-8 T8-9 T10-11 T9-10 LUMBAR FACET JOINT REFERRAL Occasional Referral L1 - L5 (10 - 16%) Lumbar Spine Region L1 to L4-5 Gluteal Region L5-S1 (68%) Fukui et al.. Lateral & Posterior Thigh L3-L4, L4-L5, L5-S1 (5-30%)