Wednesday, October 1, 2014
Wisdom Wednesday: Visceral Referred Pain
Visceral referred pain (VRP) is an important concept in the evaluation and treatment of patients. In brief, it is a location on the skin of referred pain from an internal organ. Virtually all organs have VRP locations. Even though you may not realize it, you are familiar with some of them.
When someone is having coronary insufficiency or a heart attack, their heart does not hurt. The referred pain (angina) is generally into the left arm but can also include the left chest, mid-back and into the jaw and teeth. In appendicitis, the pain is referred to the skin over the pancreas. Gallbladder problems often refer pain into the right shoulder. When the kidneys are inflamed (think kidney stone) the pain is referred down the sides into the outer aspect of the thighs.
We use these VRPs initially as diagnostic tools. When a new patient comes in with right shoulder pain, the gallbladder is in the differential diagnosis. If they also note right sided abdominal pain late at night, especially after a heavy evening meal, gallbladder moves to the top of the list. Treating the right shoulder as a mechanical issue with manipulation and therapy will often provide good temporary relief. However, the pain will always return if the gallbladder is the real issue.
VRPs are also used in muscle testing challenges. Pinching a VRP stimulates the nociceptors (pain receptors in the nervous system) and stimulates the sympathetic system (fight or flight). Rubbing a VRP stimulates the parasympathetic system (increases digestion, calms everything else).
Challenging a VRP helps locate the source of a health issue. It can also be used to temporarily negate a reflex. If, for example, I find a histamine response to wheat sensitivity has an active VRP to the small intestine, I can stimulate the VRP, temporarily shutting the reflex off. This allows me to move forward in the QA (Quintessential Applications) protocol. Otherwise, I would have to wait weeks or even months until the histamine issue was resolved to test further.
Stimulating VRPs can also provide significant temporary relief. I have stopped gallbladder attacks in my office by stimulating the gallbladder VRP. The relief is almost instantaneous. Of course you still have to treat the gallbladder to reduce the inflammation, improve bile flow, and possibly thin the bile to resolve the problem. However, when stimulation of a VRP provides such relief, the diagnosis become quite easy.
Many VRPs are directly over the organ (viscera) in question. This is the case for virtually all of the digestive system. The stomach VRP is over the stomach and the small intestine VRP is over the small intestine. However, some like the well-known VRPs noted above are in seemingly unusual locations. The VRP for the Valves of Houston (located in the anus) is in the abdomen, half way between the umbilicus and anterior crest of the ileum.
Chapman’s Reflexes are similar points on the skin surface. Dr. Chapman was an osteopath that described these reflexes during the 1950’s. He traveled from hospital to hospital interviewing patients about the location of their pain and correlated that with their diagnosis. Today, we use Chapman’s Reflexes for treatment purposes. For example, I might find an active thymus VRP which is on the right side where the neck meets the shoulder. However, I will treat using Chapman’s Thymus Reflex which is at the lateral aspect of the right rib cage. When done properly, treating the Chapman’s Reflex will negate the VRP to the same organ.
THE BOTTOM LINE:
Pain is a warning signal that something is wrong in the body. That warning signal tends to be specific to the location of the problem. Please pay close attention to any pain signal from your body and describe it in detail to your physician.