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Diagnosing and Treating Referred Pain

Referred pain describes the experience of feeling mild to severe discomfort in an area distant from the actual cause. For example, a knee ache may have nothing to do with your knee (the localized area) at all. Instead, it could indicate an underlying condition in the hip or foot area.

Although medical experts are unsure exactly why the source of pain is, at times, divorced from the affected area, they do recognize that referred pain is a real symptom, rather than psychosomatic (the result of a mental disorder). Most agree, too, that specific types of referred pain are indicative of serious underlying conditions. These include:

arthritis
gall bladder disease
heart attacks.

Referred Pain Overview

Although some experts put referred pain in the same category as “radiating pain,” others separate them as two distinct conditions. Radiating pain generally includes instances in which pain travels across a naturally connected network of nerves. For instance, if you have a herniated disk in the lower back, you could feel shooting pains down your leg due to the shared nerve network.

Alternatively, referred pain is characterized by the sensation of pain in an area that doesn’t share the same nerve network as the root source of the pain.

Like other types of pain, referred pain can be acute or chronic, dull or sharp and internal or external, depending on the original source of the pain and the degree of the injury.

Causes of Referred Pain

While the precise causes of referred pain remain unknown, here are a few of the leading theories:

Theory 1: Referred pain is caused by the intersection of unrelated nerve pathways. When the “wires get crossed,” sensation from one part of the body can be mistaken for pain in another.

For example, internal organs contain fewer nerve sensors that the skin, which is highly sensitive. When pain signals from the liver mingle with receptors from the skin, the higher sensitivity may win. As a result, discomfort plagues the limbs and surface muscles, rather than the liver itself.
Theory 2: Referred pain is the result of the brain’s inability to properly interpret the signals the body is sending it. As a result, the brain perceives the pain in an entirely different area than the original source.

Likely, some combination of crossed nerves and the brain’s misinterpretations causes referred pain.

Referred Pain Symptoms and Common Examples

The symptoms of referred pain depend on the affected area, the degree of injury and a patient’s current health. Here are some common scenarios in which people experience referred pain:

Amputations: Phantom pain is the phenomenon in which amputees experience discomfort in extremities that are no longer there (i.e. feeling pain in the leg that has been amputated). While this sensation may be due to the fact that the brain is misinterpreting nerve endings, it can also result from crossed nerve impulses at the amputation site.
Arthritis: Joint pain is common with arthritis, but other parts of the body also suffer. Arthritis can cause referred pain in the groin and thighs. Similarly, those with osteoarthritis typically experience referred pain in the upper neck vertebrae upper back region.
Gall bladder, liver, spleen problems: Referred shoulder pain can indicate disease of the gall bladder, liver and spleen. Even appendicitis can send pain signals to the right shoulder.
Heart attacks: Symptoms of a heart attack, including arm and neck pain with chest tightness, are common instance of referred pain. While the heart itself is affected and projects no sensations, surrounding, unconnected tissues exhibit sensations of pain.

Diagnosing Referred Pain

Diagnosing referred pain can be difficult due to the fact that the source of pain is not necessarily in the same nerve network or area of the body as the sensation of pain.

Helping Your Doctor With Diagnosis

If you start to experience odd pain, keep a pain diary to track:

how often the pain arises
severity of pain
when you typically experience pain.

Bring the diary to your doctor so he can use the information to help with diagnosis.

See your doctor and bring details on your pain to your visit. Keep in mind, the earlier you get professional help, the more likely that treatment will lead to a possible cure.

During your doctor’s visit, the physician will inspect the area of reported pain to identify localized tenderness, which would rule out a referred pain condition. If a patient is suffering from radiating pain, rather than referred pain, he will have two very different treatment regimens.

Next, your doctor will ask you to rate the pain on a scale up to 10, with zero being the lowest level. Because personal perception of pain is entirely subjective, doctors take into account that people have different reactions to pain.

The doctor may explain potential conditions based on referred pain charts. These charts feature highlighted areas of the body known to react to different types of internal triggers. For instance, nerve bundles from a variety of organs may congregate in specific vertebrae quadrants that cause conflict when sending pain messages to the brain. An injury to the upper part of the neck can present symptoms between the shoulder blades. A headache or jaw pain might be symptomatic of a condition in the vertebrae as well.

If your doctor doesn’t specialize in the type of condition from which you suffer, consider getting a referral to a pain clinic that can effectively diagnose and treat your condition.

Referred Pain Treatment

Because finding the source of referred pain can be tricky, getting the proper treatment can take time. While you and your doctor work towards diagnosing the source of pain, take these steps to alleviate pain in the interim:

acupuncture and/or acupressure
apply heat and/or ice
exercise when possible
massage
rest for a day or two between exercising
routinely stretch your muscles
seek physical therapy, if appropriate.

Your physician may also recommend over-the-counter and/or prescription medications to help provide pain relief.

Resources

Benjamin, Ben PhD (2007). Referred Pain. Retrieved August 27, 2007, from the Massage Today Web site: http://www.massagetoday.com/mpacms/mt/article.php?id=10247.

Merck.com (nd). Introduction. Retrieved August 28, 2007, from the Merck & Co., Inc. Web site: http://www.merck.com/mmhe/sec06/ch078/ch078a.html.

Spine-health.com (2007). Low Back Pain with Referred Pain. Retrieved August 27, 2007, from the Spine-Health Web site: http://www.spine-health.com/topics/cd/hurt/h03.html.

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