Somatic Pain

• Somatic Pain:

  • ‘Pain spreads into lower limbs and is perceived by nerves other than those that innervate the site of noxious stimulation’ (Bogduk, 2009)
  • Source is somatic tissues
  • No stimulation of nerve roots
  • Produced by noxious stimulation of nerve endings within spinal structures (e.g. disc, facet joint, SIJ)
  • General rule: pain perceived in regions that share the same segmental innervation as the source
  • Examples: discs, zygapophysial joints, or SIJ
• Clinical Presentation of Somatic Pain - History and MOI:

  • Traumatic or gradual insidious pain
• Clinical Presentation of Somatic Pain - Subjective Features:

  • No neurological signs or symptoms reported
  • Can present with morning stiffness e.g. OA, spondylosis
  • Aggs and Eases depend on involved structures (if any)
  • Dull / deep / aching / gnawing pain
  • Can be described as pressure or expanding pain
  • Pain can be referred along a course specific pattern associated with the structure at fault (but debateable!)
  • Generally in buttocks, proximal thigh, but can travel towards the leg
• Clinical Presentation of Somatic Pain - Objective Features:

  • Decreased ROM and poor quality of movement due to pain / stiffness
  • Posture?
  • Negative neuro integrity test
• Clinical Presentation of Somatic Pain - Key impairments:

  • Pain
  • weakness
  • decreased ROM
  • depending on involved structures
• Clinical Presentation of Somatic Pain - Does this patient warrant a scan?

  • if they have referred pain/other symptoms we do a neural integrity test
  • if test comes back negative then the patients does not need a scan
  • even if the test results show there is some neuro compromise then we wouldnt be labelling it as somatic pain, but maybe radicular pain
  • pts only need a scan if we think theres red flags or theyre unstable neurologically or if we think their neuro is progressive
  • true somatic pain does not require a scan unless symptoms change down the line