Referred Pain

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Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain can also present as a sharp or dull sensation to the affected area. It may come and go, or it may be constant (chronic). You may feel pain in one area of your body, such as your back or abdomen, or you may feel pain all over. There are two types of pain – acute and chronic. Acute pain typically comes on suddenly, possibly because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain. Chronic pain lasts for a long time and can cause severe problems.

Referred pain is a type of pain that is perceived to be in one location other than where the pain stimulus is. For instance, if you were to place your elbow in a bucket of ice water, you will feel pain in your hand and not in your elbow. The reason being is because in your elbow is the ulnar nerve and when you submerge it in the freezing water, the pain that you would feel in your elbow is now shooting up your arm into your hand. Therefore, your hand is not in the freezing water, yet you still feel the pain there and not in the elbow. Another example of referred pain would be when you drink an ice-cold drink very fast, thus leading into what is known as a “brain freeze”. Although your brain isn’t being affected, the pain stimulus that you are getting makes it feel as if it is.

Oftentimes, referred pain can be mistaken for another type of pain called radiating pain. The difference between the two is that with radiating pain, the pain is where the pain stimuli are, but causes the pain to radiate in another direction. Whereas with referred pain, if there is pain in your lower back, for example, the root-cause to the pain may be tight hamstrings or hips muscles making you believe that its lower back pain.

Causes & Symptoms

Generally, referred pain occurs because the nerves in your body are all connected; when your body experiences a pain stimulus, your nervous system carries the signal to your brain. Afterward, the brain sends a signal to your body that you’re experiencing pain.

Sometimes, because of how nerves are wired in your body, your brain will send a pain signal to a different part of your body than the area where the pain stems from. Also, synapses and reflexes that you may not even be aware of may also be the reason pain signals are sent to one area of the body as a sign of a medical issue in another area.

Referred pain can generally be felt anywhere, which is part of why it can be very difficult to diagnose correctly. Some common areas that are affected by referred pain include the following:

  • Shoulders and neck – Pain in your shoulders and neck can be a sign of an injured spleen, a heart attack, or a liver cyst.
  • Upper back – Pain in the upper back area, right below and between your shoulder blades, can give you an indication that you have a stomach condition.
  • Teeth and jaws – Pain in your teeth and jaws can be an early symptom of a heart attack.
  • Lower back and sides of your body – An aching on the sides of your back or even close to your oblique muscles can be a sign that there is something going on with your kidneys or your colon.

As mentioned earlier, referred pain can occur in most parts of the body. Furthermore, referred pain is also commonly caused by trigger points referral or nerves referral, as described below:


Trigger points referral

These are taut bands of muscle that can cause pain at a completely different area of the body. Although the reason why trigger point referred pain exists is still unclear, the pattern or referral is often the same for every person, and releasing trigger points can alleviate symptoms far away from the area that is being treated. A common trigger point is in the muscles at the base of your head, which causes pain behind your eyes or above your ears.

Nerves referral

When for various reasons nerves are impinged or damaged at their root in the spine, pain may be felt in areas of the body supplied by the damaged nerve. For instance, a slipped disc in the lower back can irritate the sciatic nerve, giving you pain and other symptoms around your hamstrings or even all the way down in your toes. This type of referral is also possible when there is nerve injury anywhere along the nerve pathway, for example, elbow pain after a shoulder dislocation that damaged the ulnar nerve.

Who gets Referred Pain?

Referred pain can happen to anyone of any age and of any gender, at any time. Referred pain can also happen in multiple parts of the body. This type of pain can affect the muscular system and the skeletal system:

  • Muscular system – Tight gluteus muscles (butt muscles) and hamstring muscles (muscles behind the thigh) can cause lower back pain because when the muscles are tight; they pull on the skeletal frame causing a misalignment, therefore, causing pain to occur in the lower back. Most people would refer to it as lower back pain, failing to assess other surrounding tissues that might cause it.
  • Skeletal system – Similar to the muscular system, if your skeletal structure is misaligned, it can pull on the surrounding soft tissues causing them to be tight and pull on other structures, which may result in a muscle spasm, tightness, or stiffness.

How Does it Affect You? How Serious is it?

Referred pain can play a role in leading a person to experience early symptoms of a heart attack. A heart attack occurs when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can’t get oxygen. If not treated quickly, the heart muscle begins to die. However, if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle.


The most common symptoms of a heart attack in men and women are:

  • Shortness of breath – Sometimes this is your only symptom. You may get it before or during the chest discomfort. It can happen when you’re resting or doing a little bit of physical activity.
  • Discomfort in the upper body – You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.
  • Chest discomfort – It is often in the center or left side of the chest. It typically lasts more than a few minutes. It may go away and come back. It can feel like pressure, squeezing, fullness, or pain. It can also feel like heartburn or indigestion.

Recommended Treatment & Rehabilitation

Unlike other diseases or health-related problems, there is no one method to diagnose referred pain. A physiotherapist will begin by asking questions to determine whether a specific physical problem is causing your pain. Your therapist may ask how long have you had pain, how did it start, where is the pain located, and when did you experience the pain. After a medical history has been done, imaging tests, such as X-rays, Computed Tomography (CT) scans, and Magnetic Resonance Imaging (MRI) may be ordered to rule out any underlying medical condition that is contributing to your pain. Your physiotherapist will refer you to other medical condition that is contributing to your referred pain.

Once your condition has been well-diagnosed, your physiotherapist will work with you to develop a treatment plan to help address your referred pain. Some of these treatments depend on which type of pain you have been dealing with, such as:


Acute referred pain treatment

If you have acute referred pain, your physiotherapist will help identify the injured tissue (bone, muscle, and tendon) and devise treatments to help promote healing and reduce stress on the injured area. Your physiotherapist will then offer guidance as to how to safely return to your regular activities without further damaging the injured tissue. Some studies have shown that people who return to their normal daily activities more quickly following injury recover faster and have fewer long-term problems than people who do not return to activity in a timely manner. Additionally, your therapist may help you identify positions that hurt and positions that do not hurt; then providing treatment and exercises to help the injured tissue more efficiently.

Chronic referred pain treatment

If you have chronic referred pain, your physiotherapist can help you identify factors that may be leading to prolonged pain. These factors may include, faulty movement patterns, muscle weakness, areas of stiffness that prevent normal motion, previous injuries, and past events that may be contributing to your referred pain, fear, negative emotions, and other behaviors or social factors that can lead to long-term referred pain. Afterwards, your physiotherapist will design a treatment program to fit your specific needs, which may include manual therapy and gentle exercises to relieve pain.

Other treatments are likely to include a combination of the following below:



Your physiotherapist will be able to determine whether to use modalities such as ice, heat, or electrical stimulation applied to specific areas that will benefit your referred pain.

Graded exposure

Because emotions such as feat are often associated with referred pain, your physiotherapist may slowly introduce movement and activity back into your life. Graded exposure may involve visualizing movement followed by slowly and safely beginning to move in ways that are pain-free, to start the process of returning to your regular activities. This type of approach has been shown to help reduce pain and restore the ability to perform everyday activities.

Movement and exercise

Moving more and exercising can often be a great strategy to lessen pain. Studies have found that those who exercise on a regular basis experience less referred pain. Your physiotherapist will help identify specific movements that will help reduce your symptoms.

Psychologically informed physiotherapy

Studies have shown that referred pain is closely accompanied by psychological factors such as fear, anxiety, and depression. Addressing these factors has been shown to help reduce the amount of pain a person is experiencing. If you have chronic referred pain, your physiotherapist will work with you to address factors like these that may be contributing to your referred pain.

Alternative & Homeopathic Treatment

You can try to treat acute referred pain at home with some simple homeopathic treatments that will reduce any inflammation and soothe your body’s nervous system. Some homeopathic treatments for acute pain include:

  • Taking hot showers with Epsom salt to release muscle tension.
  • Using a warm compress to ease muscle tension.
  • Resting your body until your pain has subsided.
  • Taking non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and inflammation.
  • Applying ice packs to help reduce inflammation. Heat packs can also be used to increase blood circulation in the affected area where you have experienced referred pain.

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