Referred pain is a phenomenon in which pain is felt in an area of the body that is different from the actual source of the pain. This can be confusing because the sensation of pain is experienced at a location distant from the origin of the problem. The term “referred” implies that the pain is referred from one area to another.
The underlying reason for referred pain lies in the way the nervous system is organised. Nerves from different parts of the body may converge onto the same pathways in the spinal cord and brain. When there is a problem or stimulus affecting one part of the body, the brain may interpret the signals as coming from another area that shares the same neural pathways. As a result, a person may perceive pain in a location different from the actual site of the issue.
One example of referred pain is the pain felt in the left arm during a heart attack. The heart and the left arm share overlapping nerve pathways, so the brain interprets the pain signals from the heart as coming from the left arm. Another common example is a brain freeze after eating something cold. The extreme cold sensation touches your mouth and throat, however you feel pain in your head.
Referred pain can manifest in various body parts and can be categorized as somatic referred pain and visceral referred pain. Somatic referred pain refers to pain originating from the musculoskeletal system, such as the muscles, joints, bones and the skin. An example of somatic referred pain is the lumbar joints, ie the joints in your lower spine, referring pain to your hamstring muscle. While the pain manifests in the hamstring, addressing the lower spine through treatment proves most effective in relieving the hamstring discomfort. Visceral pain, on the other hand, originates from the internal organs, known as the viscera, such as the heart, liver, intestines, and other organs. An example of visceral pain is when there is an issue with the gallbladder, such as gallstones, you may feel pain in your shoulder or upper back.
In most cases, Physiotherapists are able to discern the source of somatic referred pain (ie muscles, joints, bones) by taking a thorough patient history, physical assessment and using their understanding of referral patterns. In the event that the pain is indicative of a visceral origin, physiotherapists will recommend consulting with a doctor for further evaluation and appropriate medical intervention.