[Symptomatic approach to referred chronic pelvic and perineal pain and posterior ramus syndrome].
OBJECTIVE
To review pseudovisceral referred pain and posterior ramus syndrome.


METHODS
A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (referred pain, low back pain, pelvic pain, abdominal pain) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time.


RESULTS
Referred pain is perceived in zones situated away from the causal lesion. In urology, pain referred to the testicular zone can be due to renal, gastrointestinal or vertebral disease. An example of pseudovisceral referred pain is the posterior ramus or thoracolumbar junction syndrome described by Robert Maigne. In this syndrome, pain is not perceived at the thoracolumbar junction, but more distally in the lumbosacral or sacroiliac region. This syndrome can also be responsible for pseudovisceral lower abdominal pain, fibromyalgia, pseudotendinitis and painful bands in a given dermatome. The usual cause of posterior ramus syndrome is minor intervertebral dysfunction involving a posterior facet joint, usually at T12-L1. Only a thorough physical examination can demonstrate the painful vertebral segment.


CONCLUSIONS
The site of the pain is not always a reliable indicator of the organ or region responsible for the pain. Clinical interview and thorough physical examination can allow the diagnosis of referred pain and, especially in posterior ramus syndrome, guide the physician to the origin of the pain in the thoracolumbar junction.
Service d'urologie-andrologie, CHR La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France. delav.uro@orange.fr
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Delavierre
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Rigaud
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Sibert
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Labat
D001416:Back Pain / Q000175:diagnosis; D002908:Chronic Disease; D006801:Humans; D017699:Pelvic Pain / Q000175:diagnosis*; D010502:Perineum; D010808:Physical Examination