Systemic vs Musculoskeletal Pain

• Systemic or viscerogenic pain differs from musculoskeletal pain in onset, description, intensity, duration, pattern, aggravating factors, relieving factors, and associated signs and symptoms.

Onset

• Systemic/viscerogenic pain has a recent and sudden onset.
• Systemic/viscerogenic pain does not remain for years without symptom progression.
• Musculoskeletal pain may be sudden or gradual, depending on the history.
• Sudden musculoskeletal pain is usually associated with acute overload stress, traumatic event, or repetitive motion, and can occur as a side effect of some medications.
• Gradual musculoskeletal pain is secondary to chronic overload of the affected part, and may be present off and on for years.

Description

• Systemic/viscerogenic pain is often knife-like, with a stabbing quality from the inside out.
• Other descriptions of systemic/viscerogenic pain include boring, deep aching, cutting, gnawing, and throbbing.
• Systemic/viscerogenic pain can be unilateral or bilateral.
• Musculoskeletal pain is usually unilateral.
• A patient may be stiff after prolonged rest, but the pain level decreases relatively quickly with activity.
• More descriptions of musculoskeletal pain achy, cramping.
• Local tenderness to palpation is usually present.

Intensity

• The intensity of systemic/viscerogenic pain is related to the degree of noxious stimuli.
• The intensity of systemic/viscerogenic pain is usually unrelated to the presence of anxiety.
• Systemic/viscerogenic pain ranges from mild to severe.
• Musculoskeletal pain may range from mild to severe.
• The pain level experienced may depend on the person's anxiety level.
• In a patient fearful of a "serious" condition, pain level may increase.

Duration

• Systemic/viscerogenic pain is constant, shows no change, and awakens the person at night.
• The duration or intensity of musculoskeletal pain can be modified by rest or change in position.
• Musculoskeletal pain may be constant, but is more likely to be intermittent, depending on the activity or the position.

Pattern

• Systemic/viscerogenic pain may come in waves.
• Systemic/viscerogenic pain is gradually progressive and cyclical, presenting with night pain.
• Symptoms of systemic/viscerogenic pain are unrelieved by rest or change in position.
• Migratory arthralgias: Pain or symptoms last for 1 week in one joint, then resolve and appear in another joint.
• Systemic/viscerogenic pain may vary depending upon the organ.
• Chest/shoulder pain can be accompanied by shortness of breath or wheezing, which suggest pulmonary origin.
• Eating may alter the symptoms, suggesting a gastrointestinal or possibly cardiac origin.
• Sitting up relieves symptoms (decreases venous return to the heart: possible pulmonary or cardiovascular cause).
• Musculoskeletal pain presents with restriction of active/passive/accessory movements.
• With musculoskeletal pain, one or more particular movements “catch” the patient and aggravate the pain.
• Musculoskeletal pain exhibits a predictable pattern of occurrence.

Aggravating Factors

• Systemic/viscerogenic pain is organ dependent.
• Esophagus: Eating or swallowing affects symptoms.
• Heart: Cold, exertion, stress, and heavy meals bring on symptoms.
• Musculoskeletal pains are altered by movement.
• Pain may become worse or decrease with movement.

Relieving Factors

• Systemic/viscerogenic pain factors are organ dependent.
• Gallbladder: Leaning forward may reduce symptoms.
• Kidney: Leaning to the affected side may reduce symptoms.
• Pancreas: Sitting upright or leaning forward may reduce symptoms.
• Musculoskeletal pain eases with rest or change in position.
• Muscle pain eases with short periods of rest without resulting stiffness, except in cases of fibromyalgia, stiffness may be present in older adults
• Stretching
• Heat, cold

Associated Signs and Symptoms

• Fever, chills
• Sweats (at any time, day or night)
• Unusual vital signs
• Warning signs of cancer
• Gastrointestinal symptoms: nausea, vomiting, anorexia, diarrhea, constipation
• Early satiety
• Bilateral symptoms (e.g., paresthesias, weakness, edema)
• Painless weakness of muscles
• Dyspnea (at rest or after mild exertion)
• Diaphoresis (excessive perspiration)
• Headaches, dizziness, fainting
• Visual disturbances
• Nail bed changes, skin rash or lesions, itching
• Bowel/bladder symptoms
• Hematuria (blood in the urine)
• Melena (blood in feces)
• Fecal or urinary incontinence
• Usually no associated signs and symptoms with musculoskeletal pain.
• Stimulation of trigger points (TrPs) can cause sweating or nausea.
• Severe pain may trigger a physiologic response (elevated heart rate, blood pressure, etc.).