Theories of referred pain from a visceral organ, using skeletal muscle as the site of referral. (Left) The convergence-facilitation theory states that painful visceral insults produce an “irritable focus” in the corresponding spinal cord segment, thus facilitating or amplifying signals from somatic structures whose nerves converge on the same spinal neurons. According to this theory, therefore, the referred hyperalgesia is mainly central. (Right) The reflex-arc theory states that viscerocutaneous or visceromuscular reflexes traveling through the spinal cord induce neurogenic changes in the muscle or skin that result in a local painful state. According to this theory, referred hyperalgesia can be viewed as peripheral. (From ref. 38.)
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