What Is Referred Pain?

At some point in your life, you have probably been eating ice cream or drinking an especially cold liquid and experienced pain in your head. Commonly referred to as a brain freeze, this phenomenon is an everyday example of referred pain. It is not your brain that is actually feeling the pain; in reality, it is the sphenopalatine ganglion nerves found behind the nose that have been stimulated.  There are a number of situations where we feel pain somewhere other than where the stimulus occurs.

Examples of Referred Pain

There are many examples of referred pain including

• Cardiac arrest—if you are having a heart attack, then you may experience referred pain or numbness in your left arm, upper middle part of your back or jaw.
• Lung and diaphragm—if you are suffering from lung or diaphragm issues, then you may find that your neck or upper shoulder area may hurt.
• Liver and gallbladder—like the referred pain involving the lung and diaphragm, injury to the liver and gallbladder may produce pain in the neck and upper shoulder area.
• Pancreas—almost half of all people with pancreatitis have pain in their back. Some may also exhibit abdominal tenderness.
• Colon and appendix—in many cases of appendicitis, pain may occur in the right side of the middle lower abdomen.
• Kidney—any issue with the kidneys can produce pain in a wide area that includes the abdomen, pelvis, lower back and upper legs.
• Ovaries—serious issues like ovarian cysts or cancer may cause pain on one side of the abdomen or the other.
• Phantom limb—some amputees may experience pain in a body part that no longer exists.

Why Does Referred Pain Occur?

It may seem strange that you would experience pain in a part of your body that isn’t being injured, and many health experts share your confusion. It is very difficult to explain why some people who are having a heart attack experience pain in their jaw.

The most mechanical explanation is that the human nervous system is imperfect and, put simply, the wiring gets crossed sometimes. In many examples of referred pain, the receptor pain nerve is connected to many other neurons in the brain. So, if the receptor is stimulated, it may produce a pain response in many other areas of the body.

Some neurologists do find fault with this theory. Many forms of referred pain appear to translate in only one direction. Take for example the heart attack scenario. Although heart pain may manifest as jaw or shoulder, injuries to these areas do not lead to pain in the left chest.

For centuries, doctors have recognized that referred pain exists, but there is no real consensus about the actual mechanism behind it. There is even less agreement about why this phenomenon exists as there appears to be no evolutionary advantage for nerves to produce pain in unaffected areas of the body.

How to Identify and Respond to Serious Referred Pain

While you may not want to visit the emergency room for a brain freeze, there are certain warning signs of referred pain that should prompt you to take immediate action.

• Heart attack—you should always seek out medical attention if you are having chest pains, but you should be especially concerned if you are also experiencing pain in your left arm. The pain may come and go, steadily ache or appear suddenly. You may also feel pain in your neck, jaw, back, shoulders or upper abdomen. If you are having any of these symptoms, you should treat it as a medical emergency and get aid as soon as possible. You should know that about 14 percent of people who suffer a heart attack will die as a result while many others that survive must endure the pain and weakness of a damaged heart.
• Appendicitis—the classic pain symptom of appendicitis is pain in the lower right belly or near your belly button. In a minor number of cases, there may be referred pain in back, lower belly or rear end. If you suspect that you have appendicitis, then you should visit an emergency room as soon as possible so that your appendix can be removed before rupturing, which is a potentially life-threatening condition.
• Ovarian cancer—if there is a cancerous growth on the ovaries, some of the initial pain symptoms may appear in the legs, lower back or abdomen. This pain may be caused by a tumor, loss of blood circulation, blockage of kidneys or bladder, or as a side effect of some cancer treatments. Needless to say, if you are experiencing any of these pain symptoms, you should see a doctor as soon as possible.

How To Treat Referred Pain

In most cases, the best way to remediate referred pain symptoms is to treat the underlying health condition. However, if the health condition is resistant to treatment, then there are ways to manage the referred pain symptoms themselves.

• Medications—your physician may initially start you on over-the-counter pain relievers like aspirin or Tylenol. If your referred pain symptoms persist and are quite severe, however, then you may be put on morphine or ketamine.
• Acupuncture—although this form of pain management has only recently gained support among the pain specialty profession, due to its low cost and low risk of side effects, it is quite commonly recommended for many pain conditions.
• Heat and ice—short-term applications of heat and ice can help alleviate pain symptoms. While icing the affected area can numb the nerves, warmth promotes blood flow which expedites healing.
• TENS—the application of a mild electrical current or Transcutaneous Electrical Nerve Stimulation (TENS) can block pain signals and prevent the source of the referred pain from transmitting a nerve impulse.
• Exercise—if the referred pain is chronic in nature, then your physician may recommend some lifestyle changes including regular exercise. Depending on the nature of your referred pain condition, your doctor may recommend low-impact physical activity like yoga, walking or swimming. Not only should this provide short-term pain relief as endorphins are produced, but the exercise should help improve your overall health.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA, and you should not post any of your private health information.