How Visceral Pain Refers and Masquerades in Low Back and Pelvis

Citing Deyo and colleagues, the speaker notes that visceral disease accounts for about 2% of back pain, twice the rate of classic red flags. Multilevel visceral innervation, convergence at the dorsal horn (where under 10% of afferents are visceral) and dormant afferents switched on by inflammation explain why visceral pain is diffuse, poorly localized and can spread widely. Dividing the abdomen into four quadrants helps when talking with medical colleagues. For central low back pain the bowel, uterus and ovaries are the main sources. The speaker covers changes in bowel habit, wind and stool, noting that 10% to 15% of UK bowel cancer patients were first labeled with irritable bowel syndrome. For ovarian and uterine causes, early signs include abdominal bloating, early fullness, changes in discharge, bleeding between periods and changes to periods, with advice on giving context for sensitive questions. Imaging cases show a megarectum, an ovarian tumor, ovarian cysts and fibroids. For sacral pain, bladder function and frank blood in the urine need follow-up.