Visceral Local and Referred Pain Patterns

Uterus

• Segmental innervation: T1-L1, S2-S4

• Possible areas of pain location:

  • Lumbosacral junction

  • Sacral

  • Thoracolumbar

Ovaries

• Segmental innervation: T10-T11

• Possible areas of pain location:

  • Lower abdominal

  • Sacral

Testes

• Segmental innervation: T10-T11

• Possible areas of pain location:

  • Lower abdominal

  • Sacral

Kidney

• Segmental innervation: T10-L1

• Possible areas of pain location:

  • Thoracolumbar junction (ipsilateral)

  • Middle lumbar

  • Lower abdominal

  • Upper abdominal

Ureter

• Segmental innervation: T11- L2, S2-S4

• Possible areas of pain location:

  • Groin

  • Medial/proximal thigh

  • Upper abdominal

  • Suprapubic

  • Thoracolumbar

  • Iliac crest

Urinary bladder

• Segmental innervation: T11- L2, S2-S4

• Possible areas of pain location:

  • Sacral apex

  • Suprapubic

  • Thoracolumbar

Prostate gland

• Segmental innervation: T11- L2, S2-S4

• Possible areas of pain location:

  • Sacral

  • Perineal

  • Testes

  • Thoracolumbar

Esophagus

• Segmental innervation: T4-T6

• Possible areas of pain location:

  • Substernal

  • Upper abdominal

Stomach

• Segmental innervation: T6-T10

• Possible areas of pain location:

  • Upper abdominal

  • Middle and lower thoracic spine

Small intestine

• Segmental innervation: T6-T10

• Possible area of pain location: middle thoracic spine

Pancreas

• Segmental innervation: T10

• Possible areas of pain location:

  • Upper abdominal

  • Lower thoracic spine

  • Upper lumbar spine

Gallbladder

• Segmental innervation: T7-T9

• Possible areas of pain location:

  • R upper abdominal

  • Central- and R-sided middle and lower thoracic spine

  • R scapula

Liver

• Segmental innervation: T7-T9

• Possible areas of pain location:

  • R middle and lower thoracic spine

  • R cervical spine

Common bile duct

• Segmental innervation: T8-T10

• Possible areas of pain location:

  • Upper abdominal

  • Middle thoracic spine

Large intestine

• Segmental innervation: T11-L1

• Possible areas of pain location:

  • Lower abdominal

  • Middle lumbar spine

  • Buttock

Sigmoid colon

• Segmental innervation: T11-T12

• Possible areas of pain location:

  • Upper sacral

  • Suprapubic

  • L lower quadrant of abdomen

Heart

• Segmental innervation: T1-T5

• Possible areas of pain location:

  • Cervical anterior

  • Jaw

  • Teeth

  • Upper thorax

  • Epigastric

  • L UE

  • R shoulder and UE

Lungs and bronchi 

• Segmental innervation: T5-T6

• Possible areas of pain location:

  • Ipsilateral thoracic spine

  • Chest wall

  • Cervical (diaphragm involved)

Diaphragm (central portion)

• Segmental innervation: C3-C5

• Possible areas of pain location: cervical spine