What is referred pain?

a lady sitting and holding her sore foot

Referred pain

This happens when the sore area broadcasts the pain to another location away from the area.

The sore structure could be a torn ligament, or a damaged muscle, or even a pinched nerve; they all have pain-generating nerves that inform the body of damage.

But broadcasting away from the sore area? That’s odd.

One explanation

Might be that, apart from skin, the pain wiring of internal structures is not precise enough to reliably localise damage/inflammation to the actual location of the problem.

The brain makes the best guess it can. Nothing is wrong with the area where the pain is perceived.

For example, left arm pain with a heart attack, or calf pain from a nasty lumbar nerve root irritation.

There are characteristic and useful patterns of referred pain, but they do vary from patient to patient.

Origins of pain

It’s worth exploring a couple of ideas about what I call local pain, a term I use to describe pain occurring in the area of the grumbling painful structures.

This is the opposite of referred pain.

A hockey ball hitting your shin bone causes local pain, because the bulk of the damage is to superficial structures like the skin and underlying connective tissue.

Quite confusing is that while structures like ligaments, tendons, muscles and joints generate pain in this way, they can, in other situations, refer pain to different locations. A muscle trigger point does this.

Then there is the particular case of the nerve bundles exiting the spinal column. These bundles (which supply sensation and power to their target skin and muscles) have a wrapping around them enveloped with small pain fibres. A nerve has its own nerves!

When these nerve bundles get sore, and they often do as they exit the spine, they refer pain down the path of the nerve.

Local and remote

Local pain might have a cause in the area of the pain, like that hockey ball, or the source might be remote.

By remote, I mean that a problem somewhere else might be causing a structure to get sore through no fault of that structure.

For example, a stiff mid-back might trigger a perfectly sound shoulder joint to work awkwardly enough that the shoulder joint gets sore.

This is a somewhat sophisticated insight but is of surprising usefulness when it comes to tracking down the causes of spinal pains.

There are degrees of remoteness.

For example, an overloaded, sore muscle might be irritable because a nearby spinal facet joint is stuck. Or because something right at the other end of the spine is not working correctly.

The patient’s view

As patients, it is only reasonable that you see your pain as being local in origin. Put another way, surely the problem is where the pain is? But often this is wrong and can be misleading regarding causes.

But this patient viewpoint does explain why a practitioner’s focus on other areas of the body can be disconcerting for the patient!

The osteopath’s view

So when an osteopath thinks about your pain, they ask themselves;

  • Is the pain local and is the primary cause of it in the same area?
  • Is the pain local but does the primary cause lie somewhere else?
  • Is the pain referred?
  • If it is referred, where is the source?

Radiating pain

The term radiating pain is used to describe referred pain that propagates in a wave-like way. This happens when the irritated structure (for example, an inflamed nerve root) gets more and more annoyed. The sorer it becomes, the further it radiates the discomfort. As the soreness eases, so the broadcasting gets closer to the source.