Segmental Signs and Spontaneous Pain in Acute Visceral Disease - Lateralization and Bodily Patterns

Abstract

The differential diagnosis of acute visceral diseases is a challenging clinical problem. The older literature suggests that patients with acute visceral problems show segmental signs, such as hyperalgesia, skin resistance, or muscular defence, whose lateralization and segmental distribution may be used for differential diagnosis. This study aimed to investigate the lateralization and segmental distribution of spontaneous pain and segmental signs in acute visceral diseases. We recruited 208 emergency room patients that were presenting for acute medical problems. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and were asked for spontaneous pain and segmental symptoms, such as nausea, meteorism, and urinary retention. We collected all findings as digital drawings on a tablet-PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated average distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters analyzing their segmental distribution and lateralization. 85 of 110 patients with a single-organ problem reported pain, while 81 had at least one segmental sign, the most frequent being hyperalgesia (n=46), and muscle resistance (n=39). While the pain was distributed along the body midline, segmental signs for the heart, stomach and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (n=37) further showed ipsilateral mydriasis. The present study underlines the usefulness of including segmental signs in the bodily examination of patients with acute medical problems.

Research hotspots and trends in visceral pain research: A global comprehensive bibliometric analysis

“…Visceral pain is a complex and heterogeneous disorder, which is considered more prominent than somatic pain and is accompanied by emotional and mood disorders (Schmidt et al, 2022). As the burden of visceral pain increases, an increasing number of researchers are studying visceral pain (Pusceddu and Gareau, 2018;Shaballout et al, 2021;Ceuleers et al, 2022;Jain et al, 2022;Long et al, 2022;Morreale et al, 2022;Zhang et al, 2022). Thus, a systematic analysis of topics in this field using bibliometric methods has been used in this study to gain a clearer understanding of the current state of research and future research trends in the field.…”

“…More than 20% of the world's population suffers from chronic visceral pain (Grundy et al, 2019;Louwies et al, 2019). One third of the US population reported pain that had lasted for more than 6 months, and chronic pain and discomfort negatively impact quality of life for those affected (Johannes et al, 2010;Gebhart and Bielefeldt, 2016;Pusceddu and Gareau, 2018;Shaballout et al, 2021;Ceuleers et al, 2022;Jain et al, 2022;Long et al, 2022;Morreale et al, 2022;Zhang et al, 2022).…”