What is referred pain?
The concept of referred pain has been around for over 50 years. It is used to describe the phenomenon of pain experienced at a site nearby or even at a distance from the pain’s origin.
It’s likely you have heard that one of the most common symptoms of a heart attack is pain in the left arm or shoulder. This is a pattern of referred pain. Fortunately, this pattern of symptom description is now well recognized, allowing medical professionals to deliver care to the right place – the heart – instead of the wrong place – the arm!
In the face, mouth, and jaw, the experience of referred pain is common. Routinely we see patients with tooth pain, gum pain, jaw pain, and ear pain when in fact, the origin of the pain symptom is coming from elsewhere. Unfortunately, patients choose the doctor they visit based on the symptom location, and this can produce a great deal of confusion and, at times, treatment directed at the wrong place.
At first, the examining doctor has no choice but to look at the site of the pain complaint, but if no findings are uncovered, the thinking of the doctor must change and focus on possible sources of referral. When the focus is not changed, treatment is delivered without success leading to patient frustration.
Though the neurologic basis behind referred pain is complicated, there are several things to understand.
- Referred pain typically does not cross the midline. If the problem area generating the pain is on the right side of the body, the pain that is experienced is also on the right.
- It is most common for referred pain to move upwards in the body. That is, pain is typically referred from the neck and shoulder to the face and jaw, not vice versa.
- Not surprisingly, if the location of the pain experienced is treated and the origin is neglected, the pain will continue.
- Though muscles are involved in the majority of referred pain problems that we see, blood vessels and nerves can also be involved in pain referral leading to more comprehensive evaluations.
As you can imagine, referred pain is often a difficult and challenging problem for patients and physicians. As a result, our evaluation is always focused on the sources of possible referral, not just on where the symptoms are focused.