What is Referred Pain?
Chiropractic treatment can be an effective treatment of referred pain
for most people.
Referred pain is not a new invention of modern therapists, but Doctors Janet Travell and David Simons
did a fantastic job in explaining it and increase the awareness by writing the book Myofascial Pain and Dysfunction: The Trigger
Point Manual in 1983.
Chiropractors are well aware of the fact that referred pain is something that affects everybody
to some extent, some more than others. As part of chiropractic training we have to learn the patterns of referred pain of
all the muscles and internal organs, this is to ensure that we make an accurately diagnosis.
Anybody who doesn't consider
referred pain in a pain condition is likely to give the wrong diagnosis, or at best fail to consider an important source of
pain.
Which structures cause referred pain?
Referred pain can be caused by the internal organs
as well as muscles, nerves, ligaments and the bones. This is referred to as visceral- (internal organs), sclerogenic- (bones),
neurogenic- (nerve) and myofascial- (muscles and ligaments) referred pain.
Patterns of referred pain
The
most well known form of referred pain by internal organs is probably feeling pain in the left arm or shoulder, when the real
cause is the heart during a heart attack. This is, of course extremely important for the chiropractor to be aware of when
you have your examination. Referred pain from the ribs can often give pain in the same distribution and it is obvious how
important it is to be aware of both causes of pain.
There are other very typical patterns of referred pain that the
chiropractor has to include in the list of diagnosis, such as pain in the right shoulder from the liver and gall bladder,
and pain in the left shoulder and mid-back from a painful pancreas.
However, the most common structures that refer pain
in chiropractic patients are the muscles, ligaments and joints. The areas that can be affected by referred pain literally
cover the whole body. Yes – the whole body.
Just to illustrate the point we will first look at a symptom such
as pain over the face and head.
In the majority of cases headache is not caused by pain from structures in the head.
For example the brain is not pain sensitive. The covering of the brain is and the blood vessels are but not the brain itself.
So the most common source of pain felt in the head is referred pain from the muscles and joints in the neck, the jaw and some
jaw and facial muscles, and also the teeth and gums.
Here is an example of muscles that refer pain to the head and you
will probably recognise some areas of pain that mirrors headaches you have had in the past.
How is referred pain generated?
Many of the nerve endings converge and share the same nerve
cell-pool in the spinal cord and as the signal travels up the spinal cord to the brain the signal ‘lands’ on the
same area as pain signals from another part of the body. The awareness of pain is felt in the thalamus (a deeper centre of
the brain) but the awareness of where the pain is coming from, the location of pain, is determined by the sensory cortex on
the surface of the brain.
The quality of the pain with referred pain varies for different structures and also varies
depending on the level of inflammation. Many textbooks on the matter like to present things as black or white. For example,
nerve pain tends to be sharp in nature but muscle pain tends to be a deep ache sometimes burning. But in clinical practise
you realise that the pain can be quite variable from one person to the next. Some muscles can give a sensation of tingling
in the area of referred pain, but tingling is traditionally considered to be associated with nerve injuries. So it is important
to know this when you attempt to diagnose a problem, because without an accurate diagnosis the treatment is bound to fail.
Why
do we have referred pain?
Very little research has been done in this area due to its complexity to investigate.
Many suggestions have been made by various people, but the fact remains that pain is there to stop us doing further harm,
it is there to tell us to slow down and reduce a particular activity. Not for us to take painkillers and carry on as if nothing
was wrong.
The fact that we sometimes feel the pain in a different area from where it comes from can best be explained
by studying embryology. The human embryo develops in different stages and some parts of our anatomy are closer together in
the beginning. As it matures these parts migrate away from each other but remain closely linked when it comes to referred
pain.
Treatment of trigger points
Chiropractic treatment includes the treatment of trigger points,
which is a big source of referred pain. If you want to read more about it go to our page on chiropractic and trigger points.
