Referred Pain vs. Origin of Pain: Understanding the Difference

The origin or source of the pain and the place where you feel it are not always the same.Understanding these concepts and avoiding common misconceptions about referred pain are crucial in diagnosis and treatment. While your pain management doctor will know about these concepts and how to identify the origin of the pain, having an understanding for yourself will help your own pain management journey.

 

What is Referred Pain? 

 The International Association for the Study of Pain (IASP) defines referred pain as “Pain perceived as arising or occurring in a region of the body innervated by nerves or branches of nerves other than those that innervate the actual source of pain.” So, the brain perceives the pain to be in a location in the body that is not where it originates.

 

One of the most common examples of referred pain includes pain in the left arm during a heart attack. You might feel referred pain anywhere in your body, and it can be caused by a variety of conditions. Common areas of referred pain include the shoulders, neck, back, jaw and teeth. You might feel back pain in your hips, groin, buttocks and thighs; groin pain in your abdominals, and hip pain in your lower back.

Understanding the Origin Of Pain 

The origin of pain is the precise location where the nociceptive or danger signal is generated within the body due to injury, illness, or dysfunction. 

 

Doctors use several methods to identify the origin of pain, including diagnostic tests, taking a detailed history, and doing a thorough physical exam. They’ll ask you about the pain's location, what kind of pain it is (sharp, dull, etc), how it started, and what seems to make it worse or better. Techniques for tracing the origin of pain may also include X-rays, MRIs, and CT scans. Nerve blocks or other diagnostic procedures may also be used to identify the origin or your symptoms. All the information combined helps to identify the exact location of the source of the pain.

 

What are the Mechanisms Behind Referred Pain? 

Essentially, referred pain is caused by the brain becoming confused about where the input is coming from. This confusion mostly comes from changes to the physiology in your body.

Some of the physiological causes of referred pain include:

Activity in sympathetic nerves (nerves that control the body’s “fight or flight” response release substances that sensitise nerve endings in the wrong place, or sometimes by restricting blood flow to the sensory nerve fiber itself).

 

Peripheral branching of primary afferent nociceptors (the brain misinterpreting messages originating from nerve endings in one part of the body as coming from the nerve branch supplying the other part of the body).

 

Convergence projection (when sensory signals from different body areas converge onto the same neuron in the spinal cord, causing the brain to misinterpret the pain source and "projecting" the pain sensation to a different location on the body)

 

Convergence facilitation (when the background activity of pain projection neurons in the spinal cord that receive input from one somatic region is facilitated in the spinal cord by activity arising in nociceptors originating in another region of the body).

 

Embryological origin: This happens when two areas of the body share embryonic tissue – tissue that was shared when the body was an embryo and then migrated to two different locations when the baby was ready to be born.

 

Referred pain can sometimes complicate the process of diagnosing the problem, as you (as the patient) don’t necessarily know that the pain you’re experiencing is coming from a different part of your body than where you’re feeling it.

 

Why is Differentiating Between These Pains  Important?

It’s vital for your doctor to distinguish between referred pain and the actual pain origin. When referred pain is misdiagnosed, you might use the wrong treatment plan, or even have an unnecessary procedure, potentially causing complications or other symptoms. The real problem will be ignored, which may make pain worse over time and cause you a lot of frustration! 

 

Diagnosing referred pain can be tricky; there are many misconceptions about pain patterns. Pain in the jaw could be misdiagnosed as an ear infection, when it’s actually a dental issue; arm pain might be misdiagnosed as a muscoskeletal problem instead of a heart attack; lower abdomen pain might be thought to be appendicitis when it might be a kidney stone.

 

Diagnostic Techniques 

Diagnostic techniques may include:

·     taking a detailed history

·      doing a thorough physical exam

·      X-rays

·      MRIs

·      CT scans

·      Nerve blocks 

Tips for Patients and Healthcare Providers 

Signs of referred pain

If you experience pain in an area of your body where you haven’t had any injury, strain, or overwork, this might be referred pain. Other things to look out for include the pain radiating to another area, or any other strange symptoms (difficulty breathing, or nausea, for example).

 

Referred pain is often a dull, aching kind of pain, in a broad area, rather than pain with a very specific character in a very concrete area.

 

How to communicate with your doctor effectively about referred pain 

 

Come to your appointment prepared, bringing any medical records or information that you think might be uselful. Be honest about your lifestyle habits, over-exertion, or anything that might affect your health. Share all the details about how, when and why the pain or discomfort started, what has helped or made it worse, and what activities you are struggling to perform. Share your concerns and fears, and try to be as clear as possible in your description of what you are experiencing.  

 

Advice for healthcare providers on maintaining a high index of suspicion for referred pain in diagnostic evaluations

 

·      Familiarise yourself with patterns that occur commonly in referred pain, from different body structures and organs.

·       Assess the patient's full medical history and symptoms to consider the possibility of referred pain.

·       Complete a comprehensive physical examination including palpating different areas of the body.

·       Include imaging tests like X-rays, MRIs and CT scans when necessary.

In some conditions, consider whether a nerve block might help you clarify if your patient is experiencing referred pain. 

 

When diagnosing referred pain and finding the true origin or source of pain, having an interdisciplinary team of health professionals working together to solve the case (and then treat it correctly) can make a world of difference.

 

While referred pain may be in your shoulder, the origin of the pain may be in your neck – the speed and accuracy of a correct diagnosis could save you months of suffering.

 

Diagnosing referred pain correctly could save you money on unnecessary procedures, cut down the length or intensity in chronic pain, and improve your quality of life dramatically. 

 

Call 087 550 0644 or email info@healthcollectiveheal.com for an appointment at any clinic.