Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
Have you suffered from sciatica? Headaches from neck or shoulder tension? These are all examples of what we commonly call referred pain. This refers to the fact of feeling pain in an area that is not even injured. Find out in detail what referred pain is in this article.
What is referred pain?
La referred pain, also called referred pain, refers to pain felt in a different area than where the injury actually is.
Common cases include sciatic pain in which the pain originates from the nerves around the lower back. However, this can lead to referred pain with sharp or throbbing pain in the lower extremity (thigh or lower leg).
Referred pain can result from musculoskeletal disorders just as it can be generated by bodily organs. A heart attack or heart problems, for example, can cause pain in the left arm or the left side of the jaw.
Referred pain theories
Although referred pain may be common, the exact science behind referred pain is not fully understood. The most common theory states that nerves that are not directly affected are stimulated.
When structures such as ligaments, tendons, muscles, and joints are injured, these can irritate nearby sensory nerves. If these nerves innervate other structures elsewhere, the brain can interpret the pain as coming from these other areas. That's what we call " referred somatic pain ».
Generally, referred somatic pain is perceived in regions that share the same segmental innervation as the source.
This type of pain is described as a dull, aching pain. It is often difficult to locate and the painful area is large. This pain is different from pain caused by injury to a nerve itself.
La radicular referred pain is another type of pain referred. It comes from a spinal nerve injury. She provokes :
- a more acute pain in a separate much smaller area;
- of paresthesias (disorders of sensation);
- a weakness of the muscles innervated by the injured spinal nerve.
The pain is felt in the area innervated by the spinal nerve. When symptoms are felt down the arm in the distribution of the affected spinal nerve, it is referred to as “ radiculopathy ».
What causes referred pain?
Referred pain is often caused by compression of a nerve or nerve root.
This nerve compression may be secondary to degenerative conditions such as a herniated disc, a degenerative disc disease or spinal stenosis (narrow lumbar canal). It can also be linked to a tumor, a injury, a infection...
Nerve irritation can interfere with signal transmission that it sends to the brain. This causes abnormal pain signals. This causes pain in nerves that are not in the affected area.
In addition to nerve compression, a bad translation of signals (meeting of the nerves at the spinal cord) can also be at theorigin of referred pain.
The brain that is unaccustomed to receiving strong pain signals from the heart may assume that these signals are coming from a nerve that is more likely to send such strong sensory signals to it. As in the case of a heart attack, the brain may assume that the pain signals are coming from the left arm and chest and not from the heart.
Common Examples of Referred Pain
Nerves allow the brain and the rest of the body to communicate with each other. This communication involves pain signals. Pain is one of the body's most important communication tools : it allows you to be alerted in the event of a problem. But sometimes the signals get mixed up and the brain tells you that an area is painful when it's not affected.
We can cite a few examples of referred pain :
- an underlying shoulder problem causing pain in the elbow,
- neck pain that radiates into the middle back ou between the shoulder blades,
- neck problems causing headache in different regions;
- of hip problems causing pain in the knee.
This is why education in movement and the relationship between body parts is important. The more central the problem, the more likely you are to feel referred pain. For example, if the source of pain is in the foot, you are unlikely to experience referred pain.
The nerves around the body all converge at some point around the spinal cord. Various nerves around the body all flow into similar aspects of the spine.
For example, the nerves that innervate the neck and upper back also innervate the upper limb and arm. As a result, when pain originates from a nerve around the neck, it can stimulate and create referred pain in the arm or shoulder. Shoulder and arm pain that originates in the neck can be common.
In some cases, the referred pain peut occur without symptoms at the original source. The sciatica is a relatively common example. The referred pain in conditions of sciatica usually occurs in the lower part of the body: the thigh or the leg. Even if the origin of sciatica is in the lower back, it can present with or without localized pain in the back or buttocks.
Clinical implication
The area of pain can be identified usingin-depth examinations. This may or may not be symptomatic.
The examination may include questioning on matters relating to:
- the onset of pain;
- history of injuries;
- the intensity of the pain;
- a description of how you feel pain.
The interrogation can then be followed by a sensation and movement test. This allows you to determine the origin of your pain as well as the factors that aggravate or relieve it.
The symptoms of referred pain vary considerably depending on location from the source of the pain. A compressed nerve in the neck or cervical section of the spine can cause pain in the shoulders, arms, or wrists. This may be accompanied by weakness or tingling.
If the compression occurs in the lumbar section of the spine, a dull ache of varying intensity may be felt in the buttocks, leg, or knee.
Your doctor will review your medical history and perform a physical exam to determine the cause of your pain and a neurological examination and imaging studies will be recommended to confirm the cause of the pain and the proper course of treatment.
Depending on the cause, treatment for referred pain ranges from conservative to surgical. Unless a serious condition is present, the conservative methods can be beneficial for treat your pain. These include:
- Rest ;
- physical therapy;
- medication.
However, if the pain does not respond to these treatments or if the condition causing the pain is particularly severe, a surgical intervention may be necessary.
Sources
https://www.msdmanuals.com/fr/accueil/multimedia/figure/neu_referred_pain_fr
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