Harding Geoff, Yelland Michael
University of Otago, New Zealand.
Aust Fam Physician. 2007 Jun;36(6):422-3, 425, 427-9.
In patients with pain in the back, chest or abdomen, it may be difficult to differentiate nonmusculoskeletal causes from musculoskeletal causes.
This article discusses the mechanisms of musculoskeletal referred pain and the key clinical features that help the practitioner differentiate such pain from nonmusculoskeletal pain, thereby informing appropriate management.
Patterns of pain referred from musculoskeletal structures in the back have been well documented from experimentally induced pain. The key features on history that point to spinal referred pain are pain on movement, tenderness and tightness of musculoskeletal structures at a spinal level supplying the painful area, and an absence or paucity of symptoms suggestive of a nonmusculoskeletal cause. Radiological investigations are often of little value in confirming a musculoskeletal cause. A positive response to therapy directed at the musculoskeletal source supports - but does not prove - a diagnosis of musculoskeletal referred pain.
对于背部、胸部或腹部疼痛的患者，可能难以区分非肌肉骨骼原因和肌肉骨骼原因。
本文讨论肌肉骨骼牵涉痛的机制以及有助于从业者将此类疼痛与非肌肉骨骼疼痛区分开来的关键临床特征，从而为适当的管理提供依据。
从实验性诱发疼痛中已充分记录了背部肌肉骨骼结构牵涉痛的模式。病史中指向脊柱牵涉痛的关键特征包括运动时疼痛、供应疼痛区域的脊柱水平处肌肉骨骼结构的压痛和紧张，以及缺乏或仅有少量提示非肌肉骨骼原因的症状。放射学检查在确认肌肉骨骼原因方面通常价值不大。针对肌肉骨骼来源的治疗产生的阳性反应支持（但不能证明）肌肉骨骼牵涉痛的诊断。
