A review of the literature relating to somatovisceral / viscerosomatic pain syndromes was conducted, and a case is presented to illustrate the difficulties frequently encountered by primary-contact health-care practitioners -- particularly doctors of chiropractic -- in determining whether an abdominal pain is being referred from the spine (somatovisceral) or a spinal pain is being referred from the abdomen (viscerosomatic). In the case presented. a right lower quadrant pain due to appendicitis was intensified by lateral pressure on the L4 spinous process, and temprarily eliminated by manipulation of the L4, L5 and right sacroiliac articulations. Following surgical removal of the appendix, the right lower quadrant pain was reproducible by lateral pressure of the L4 spinous process. It was concluded that if spinal manipulation can in fact relexly modulate such visceral pain, practitioners should be alerted to the possibility that manipulation of the spine may mask the pain of an ongoing pathology, and that reduction of symptoms following manipulative procedures does not necessarily imply removal of the cause of those symptoms.
Author keywords: manipulation, orthopedic, lumbosacral region reflex pain, abdomen, acute, appendicitis
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