DRUGS that Can EFECT the MUSKULOSKELATL System:

1. Joint pain:
a. Statins (cholesterol medications)
b. Osteoporosis medication (risedronate)
c. Asthma inhaler (fluticasone)
d. Breast cancer meds
e. Acne treatment (absorica, acutane)
f. Antidepressent (venflafaxine)
g. Nerve pain- lyrica, gabapentin
h. Blood pressure meds (caredilol)

Sources of Visceral Pain

Some of the sources of visceral pain include:

 Inflammation - eg. Appendicitis

 Distention - eg. Bowel Obstruction
 Ischemia - eg. a tumour blocking blood supply

Clinical Presentations

Aortic Aneurysm Back pain that is acute, severe and tearing.

It is a true medical emergency.
Pain can radiate to the anterior chest.
Rest does not relieve it.
Palpation over the back and changes in position do not aggravate the pain.
Palpation of the abdomen may increase pain.
Loss of lower extremity pulses may occur as the dissection progresses.

Myocardial Back pain is usually mid thoracic and may radiate to the arm or axilla.
Infarction Pain may be unaffected by posture or changes in position.

Typical symptoms being:

Anterior chest heaviness

Crushing chest pain
Diaphoresis (excessive sweating)
Sense of impending doom
Pain radiating to the shoulder, neck, arm(s).

Acute Pancreatitis Can cause thoracolumbar back pain.

 Often triggered by binge drinking or gallstones.

Duodenal Ulcers Vague abdominal and back pain.

Pain often worsens with hunger or with high acid levels in the stomach.
Pain often lessens with use of antacids.

Urinary Tract Pain is often across the back and radiates to the groin.
Infections Patients often report dysuria, urgency and frequency.
If the infection affects the renal system the pain is often more severe and can
radiate to the upper back.
Fever may also be present.

Prostatitis Characterised by fever and a vague aching pain in the lower back that radiates
into the rectum.

Gallstones Patients can experience severe pain in the abdominal or back area when fatty
meals are consumed.
Pain is colicky (sharp episodic pain occurring at intervals) with periods of
improvement and relief.

Kidney Stones Common in middle aged men and women.

Interruption of urine flow results in severe pain that may radiate from the
thoracolumbar region around to the lower abdomen and groin.

Visceral Cancer Vague low back pain can be the first sign of visceral cancer.
Pain is often not relieved by rest and may be most intense at night.
Pain progresses regardless of modification of activities and use of medication.

 Lungs — pain is referred in a collar-like band completely around the neck from about the C6 to
T3 levels.
 Diaphragm — pain is referred in a pattern similar to the lungs.
 Heart — pain can be referred to the area around the mouth, but is more commonly referred over
the left chest and contiguously down the anterior left arm and directly to the mid-back between the
scapula from T4 to T7.
 Gallbladder — pain is referred to superior and lateral right shoulder, offset superior similar in
size and circular shape to the superficial distribution of the axillary nerve.
 Liver — pain is referred in a similar pattern to the heart, but only on the right hemi-body.
 Stomach — pain is referred just to the right of midline in the epigastric area and to the mid-back,
just below the referred angina from T7 to T9.
 Ovaries — pain is referred to the skin area immediately over the ovaries anteriorly and directly
posteriorly, but more lateral.
 Appendix — pain is referred to Mcburney’s point in the right hypogastric area.
 Kidneys — pain is referred to the skin area somewhat below the kidneys, posteriorly only, and
medial to the posterior referred ovarian pain; there is also an area half way down the right lateral thigh,
the right chest just to the right of the lower sternum.
 Ureters — pain is referred to an anterior band across the pelvis, including the groin and the
genitals, but not extending around to the back.
 Bladder — pain is referred to a continuous area encompassing the sacrum from S2 down to the
upper medial thighs.