Somatic pain

As its name implies, deep somatic pain is generated in deep body structures, such as the periosteum, muscles, tendons, joints, and blood vessels. This type of pain is more diffuse than cutaneous pain. It may be elicited by strong pressure, ischemia, and tissue damage. 

Pain receptors also influence the medullary respiratory center. Pain may cause a reflex increase in ventilation in the form of a "gasp." Somatic pain typically causes hyperpnea and visceral pain typically causes apnea, or decreased ventilation. 

Deyama, S., Nakagawa, T., Kaneko, S., Uehara, T., and Minami, M. (2007a). Involvement of the bed nucleus of the stria terminalis in the negative affective component of visceral and somatic pain in... 

In general, pain (acute or chronic) arising from the somatic structures (skin, muscles, bones, joints) responds to NSAIDs. Acute pain arising from viscera, which is poorly localised, unpleasant, and associated with nausea is best treated with morphine but this induces dependence with prolonged use. This distinction is not, of course, absolute and a high-efficacy opioid is needed for severe somatic pain, e.g. a fractured bone. Mild pain from any source may respond to NSAIDs and these should always be tried first. 

Somatic Pain Aching, throbbing pain of skeletal muscles, fascia, ligaments, vessels, and joints treated with NSAIDs... 

Nociceptive pain typically is classified as either somatic (arising from skin, bone, joint, muscle, or connective tissue) or visceral (arising from internal organs such as the large intestine or pancreas). While somatic pain most often presents as throbbing and well localized, visceral pain can manifest as pain feeling as if it is coming from other structures (referred) or as a well-localized phenomenon. We can think of nociception in terms of stimulation, transmission, perception, and modulations (Table 58-1). 

Somatic pain—Pain arising from skin, bone, joint, muscle, or connective tissue. 

Another categorization considers pain from its point of origin. Thus visceral pain emanates from nonskeletal parts of the body, such as gastric pain, intestinal cramps, and colic. The so-called nonnarcotic or milder analgetics are usually ineffective in these instances. Somatic pain emanates from muscle and bone and includes headaches, sprains, and arthritic pain. 

These ore used particularly in the treatment of dull, poorly li alizcd (visceral) pain. Somatic pain is sharply defined and may be relieved by a weak opioid analgesic or by a non-stemitlal ami-inflammatory drug (NSAID, Chapter i2). Parenteral morphine is widely used to treat severe pain and oral morphine is the drug of choice in terminal care. 

There are six classifications of pain acute pain, chroiuc pain, visceral pain, somatic pain, neuropathic pain, and psychogenic pain. Pain can be treated non-pharmacologically or pharmacologically. 

Dundee JW. Alterations in response to somatic pain associated with anaesthesia. II. The effect of tiiiopentone and pentobarbitone. BrJAnaesffi (1960) 32,407-14. 

Since the primary purpose of this review is to study the opiates and their immediate derivatives, it is not proposed to examine in detail the interactions of the weak, peripherally-acting analgesics with neuronal transmitters readers interested in this group of drugs per se may consult reviews by Randall [4] and De Stevens [5]. However, this is not to totally dismiss as unimportant the role of central neuronal transmitters in the formulation and perception of some forms of chronic inflammatory or somatic pain a number of recent reports have demonstrated the value of certain tricyclic anti-depressant agents in alleviating this type of pain in man [6,7]. 

A distinction can be made between visceral pains, which originate in the intestines, and somatic pains, which can be localised on the skin, in muscles, connective tissue, bones and joints. Visceral pain is duU and resembles those reactions, which accompany deep pain. 

Somatic pain is subdivided into deep pain, which often carmot be precisely locahsed and spreads into the surroundings, and surface pain, which can generally be weU localised. The latter may be further subdivided into the initial pain, which normally induces a reflexive flight reaction (like the pulling away of a finger from a hot cooker plate), is easily localised, and rapidly abates after the end of the stimulation, whereas the second type of surface pain appears after a short interval as duU and biuriitigs it is more difficult to localise and subsides only more slowly. 

Somatic pain treatment with OxyContin for patients with osteoarthritis, back pain and pre- and post-operative pain is well documented. Round-the-clock controlled-release oxycodone therapy seems to provide effective analgesia for patients with chronic, moderate to severe, osteoarthritis-related pain. 

Non-opioid analgesics (NSAIDs, COX-2 inhibitors, APAP), including celecoxib, are part of the World Health Organization s (WHO) analgesic ladder for the treatment of mild to moderate cancer pain. There are no celecoxib dosing guidelines for the treatment of somatic pain associated with cancer. 

Aspirin may be used alone to treat mild to moderate somatic pain, or in combination with an opioid analgesic such as oxycodone or hydrocodone to treat more severe pain. The common dose of 650 mg of aspirin PO or PR has been demonstrated to be as efficaciotis as 10 mg of morphine administered IM. The maximum dose is 6 g/day in divided doses. It is often prescribed for the treatment of arthritis and other rheum atological pain. The dose of aspirin for the treatment of rheumatological pain is 3-4 g/day in divided doses. With regard to the treatment of migraines, 650 mg of aspirin can also be combined... 

Somatic pain responds well to NSAIDs and narcotics. Visceral pain, deep and poorly localized, caused by irritation of the serous or distension or ischemic tissue (for example pain associated with nephrolithiasis or pancreatitis) responds better to narcotics. In some cases, however, the narcotics themselves can exacerbate the problem (for example in case of bile duct obstruction). Neuropathic pain is characterized by excruciating burning pain, and is frequently associated with hypersensitivity. It maybe more responsive to anticonvulsants and antidepressants than to opioids. 

T8-T9 somatic dysfunction is usually found with renal disease. It assists in the diagnosis of a renal problem and should be treated to assure that there is no negative autonomic feedback to the kidney from the soma and to relieve some of the somatic pain associated with the kidney stone. 

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