Referred Pain from Visceral Disease Diseases of the thorax, abdomen, or pelvis may refer pain to the posterior portion of the spinal segment that innervates the diseased organ. Occasionally, back pain may be the first and only manifestation. Upper abdominal diseases generally refer pain to the lower thoracic or upper lumbar region (eighth thoracic to the first and second lumbar vertebrae), lower abdominal diseases to the midlumbar region (second to fourth lumbar vertebrae), and pelvic diseases to the sacral region. Local signs (pain with spine palpation, paraspinal muscle spasm) are absent, and little or no pain accompanies routine movements of. | Chapter 016. Back and Neck Pain Part 10 Referred Pain from Visceral Disease Diseases of the thorax abdomen or pelvis may refer pain to the posterior portion of the spinal segment that innervates the diseased organ. Occasionally back pain may be the first and only manifestation. Upper abdominal diseases generally refer pain to the lower thoracic or upper lumbar region eighth thoracic to the first and second lumbar vertebrae lower abdominal diseases to the mid-lumbar region second to fourth lumbar vertebrae and pelvic diseases to the sacral region. Local signs pain with spine palpation paraspinal muscle spasm are absent and little or no pain accompanies routine movements of the spine. Low Thoracic or Lumbar Pain with Abdominal Disease Peptic ulcers or tumors of the posterior wall of the stomach or duodenum typically produce epigastric pain Chaps. 87 and 287 but midline back or paraspinal pain may occur if retroperitoneal extension is present. Fatty foods are more likely to induce back pain associated with biliary disease. Diseases of the pancreas produce back pain to the right of the spine head of the pancreas involved or to the left body or tail involved . Pathology in retroperitoneal structures hemorrhage tumors pyelonephritis produces paraspinal pain that radiates to the lower abdomen groin or anterior thighs. A mass in the iliopsoas region often produces unilateral lumbar pain with radiation toward the groin labia or testicles. The sudden appearance of lumbar pain in a patient receiving anticoagulants suggests retroperitoneal hemorrhage. Isolated low back pain occurs in 15-20 of patients with a contained rupture of an abdominal aortic aneurysm AAA . The classic clinical triad of abdominal pain shock and back pain occurs in 20 of patients. Two of these three features are present in two-thirds of patients and hypotension is present in half. The typical patient is an elderly male smoker with back pain. Frequently the diagnosis is initially missed because the .
