What Is Referred Pain And What Causes It?
What Is Referred Pain?
Referred pain is a pain sensation felt away (or “referred”) from the origin of your pain. For many of us, this is a difficult concept to grasp. When we hurt in a specific area, we think that area is causing the pain. That is many times the case, but not always. Referred pain makes us believe we have something wrong with one part of our body, when in fact it’s a different part that is the real issue.
What Causes Referred Pain?
Referred pain is best explained from an embryological standpoint. When we are an embryo, we start as a small huddled mass that unfolds and in the center of it is the area the transforms into our spinal cord. The spinal cord has these tiny filaments that branch off from the cord called nerves. They go to all parts of our body, including our internal organs, to our skin, and our extremities. There isn’t just one nerve to each organ or part of the body.
Many times there is a bundle of nerves that goes to a general area that sends and receives signals to make that particular area function correctly. When a specific area is functioning right, it will send messages back to the spinal cord, which in turn sends signals to the brain. These signals tell the brain something is wrong, much like a check engine light. The brain then sends signals back down the spinal cord to find a solution to the problem and fix the malady. Because nerve signals overlap many times in response to the ailment, we may feel referred pain signals.
Examples of Referred Pain
There are several examples of referred pain. Some referred pain signals are indicative of organ problems, while others are a result of issues with skeletal tissues.
At my chiropractic clinic, we had a patient come in recently who was experiencing pain in her right shoulder. The initial diagnosis by a physician as they are doing an exam would be to assess what she may have done to her shoulder. Is it a sprain or strain? Tendonitis? Bursitis? Maybe she has a rotator cuff injury? Those are the pain here/problem here diagnoses that one initially considers.
This patient, on the other hand, had something else going on internally that was causing her pain. I did an orthopedic test on the patient. I checked for something called “Murphy’s sign,” which was positive. This is an abdominal maneuver performed during a physical examination. The results of this particular test indicated there was an inflamed gallbladder, which other physicians had missed. The patient said she didn’t think it was her gallbladder. She thought she sprained her shoulder (where she was experiencing the referred pain signal). Fast forward to the next week, the patient and her husband both came in to tell me she had to go to the emergency room for intense pain. They discovered gallstones and an inflamed gallbladder, which she needed to have removed.
Another example is a teenage male patient that was experiencing knee pain. It seemed to start as a knee sprain but perpetually got worse. In fact, the pain got so bad, he started using a brace, then started walking with a cane, and finally crutches. It got to the point where just the bouncing from using the crutches would bring the patient to tears. We found out the pain in the knee wasn’t the problem at all. There was an issue with the hip. The young man required hip surgery. Once the hip was fixed, the knee pain went away.
Other Referred Pain Examples Include:
- Pain in the teeth or jaws, which is one of the first signs of a heart attack.
- Pain felt in the left shoulder and down the arm may be another sign of a heart condition.
- Back pain which may be caused by a condition in the pancreas.
How To Identify The Origin of Your Referred Pain
The best way to identify the origin of your pain is to seek medical advice from a professional, and not rely solely on internet search engines. Many times the physician can identify the problem just from understanding the patient’s detailed medical history. In the patient with the gallbladder issue mentioned previously, a physician should be able to pick up on that rather fast. When this patient came in, she presented with a textbook case of all the warning signs. Typically gallbladder issues show up in Caucasian females over 40 who are above their recommended body mass index. This patient was, which made it easier to diagnose her. The proper diagnosis helps to treat the patient effectively so they can get appropriate treatment and be on the road to excellent health again.
The other patient used in the example above was a textbook case of hip pathology. To share more about the history of the patient, he was a 15-year-old male overweight who had just gone through a growth spurt. Only with this little piece of information, the first thing that pops in a clinician’s mind is a condition called Slipped-capped Femoral Epiphysis. This diagnosis sounds technical, and it is, but that is why doctors spend so much time in school. We learn these diagnoses to help you, so you don’t use the internet as your sole source of evaluation.
If you are experiencing pain and you are not sure of the origin of your pain, it would be a good idea to have a skilled practitioner evaluate your condition to get to the root cause. If you don’t feel satisfied with a general medical doctor, try seeking a naturopath. Naturopaths are also medical doctors, but they are trained to spend more time understanding the root causes of the pain rather than just treating the symptoms.