Pain referral patterns osteotomes versus dermatomes

[pastafan]

We normally deal with dermatomal pain due to spine pathology. I have always been puzzled by how injecting a patient for trochanteric bursitis often relieves their lower back pain.

A neurologist friend pointed out to me that this makes sense when you consider the osteotome pain referral pattern. I pulled out Brown's Atlas of Regional Anesthesia and looked at the osteotome diagram. The bone pain referral is to L5.

I may be the only one that missed this but I found it interesting to learn about this explanation.

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[epidural man]

It also makes sense when you realize, chronic pain has little to do with nociception, and everything to do with emotion and cognition. So when you alter ANY of the sensory input, I suspect the patient will - for a short time - get relief because of their altered belief state.