Referred Pain

                          Referred Pain

Referred pain is when pain is located away from or adjacent to the organ involved for instance. Referred pain perceived at a location other than the site of painful stimulus. Example of referred pain is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in neck, shoulders, and back rather than in the thorax (chest), the site of the injury. The International Association for the Study of Pain has not officially defined the term; hence several authors have defined it differently.

Radiating pain is slightly different from referred pain; for example, the pain related referred pain; pain related to myocardial infarction can be referred or radiating pain from chest. Radiating pain is pain that starts in one area and spreads until a larger area hurts. Sometimes this is due to nerves; for example - if a nerve gets pinched or pulled, it may hurt all along the nerve instead of just at the one spot that got hurt.

Referred pain has been described since 1880s. The biological mechanism of referred pain is unknown, despite an increasing amount of literature o the subject.

Characteristics of referred  pain

Referred pain patterns originate from viscera and myofascial trigger points. Each type of presented in more detail below.

• Radiation is related to spinal segmental.
• Perceived pain site and pathology are not on the same side of midline.
• Usually felt deeply.
• Referred distally within a dermatome, but not necessarily throughout the whole dermatome.
• May be contiguous with or may be separated from pain origin.

Causes

Simply stated, referred pain happens because the nerves in body are all connected. When body experiences a pain stimulus, nervous system carries the signal to brain. The brain then sends a signal to body about 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.

 

Researchers are still working to understand exact mechanism and reason why body has this type of reaction.

Some frequent causes of pain:

1. Heart Attack- Heart attack is one of the common reason. Referred pain can be felt in your jaw, teeth and shoulders. It is known as angina.

The pain occurs when your body starts to react to a blockage in heart valves that can trigger a heart attack.

2. Phantom limb pain- Phantom limb pain is defined as pain that is localized in the region of the removed body part (amputated limb). It's common to feel pain that body part that was removed.

For example: Subject might feel pain in his upper thigh from a foot that has been amputated.

 

3. Kehr's sign- Kehr's sign is occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classic symptom of a ruptured spleen.

4. Brain freeze- Brain freeze that you get after drinking a milkshake or eating ice cream could be considered a type of referred pain.

Common areas affected

1. Shoulder and neck-  Pain in shoulder and neck can be a sign of - 1. An injured spleen

                2. A heart attack

            3. A liver cyst

2. Upper back- Pain in upper back area right below and between shoulder blades can give an indication of a stomach condition.

3. Teeth and jaws- Pain in teeth and jaws can be early symptom of heart attack.

In the guidance of,

Dr Rajesh Gautam ( PT)