Hyperalgesia of a somatic area that is referred from diseased or inflamed viscera is a common clinical observation. It is particularly noticeable in conditions in which visceral pain occurs intermittently (e.g., dysmenorrhea), inasmuch as the referred hyperalgesia often continues during the pain-free periods. Patients report the experience of "tenderness" in the referral zone. Referred hyperalgesia has been quantified in patients with a variety of different visceral pain states and has also been measured in animal models of visceral pain.3,4 Referred hype-ralgesia is more pronounced in subcutaneous tissues than in the skin and, in most cases, is directly related to the duration and intensity of episodes of visceral pain.5 The referral zone may also manifest trophic changes such as an increase in the thickness of the subcutaneous tissues and a reduction in muscle volume, which have been localized ipsilateral to painful organs.6
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