We’re generally quite familiar with pain being caused in one area of the body and felt in another. One example of this is sciatica. This is where a nerve is irritated, and symptoms are felt along the length of it. Referred pain has some similarities, but is a completely different process.
Referred Pain Basics
There have been cases of people suffering heart attacks but having no chest pain. Instead they might get pain in the arm or jaw. This is an example of referred pain. Another example is pain referred from the SIJ, which can be mistaken for sciatica.
The nerve that supplies the SIJ also supplies the back of the thigh and calf. If the joint is irritated, the brain gets a message from the nerve to say there’s a problem. But sometimes, the brain interprets that message as pain somewhere else within that nerve’s territory. Sometimes the patterns of pain are not so cleanly defined by the nerves themselves, but by trigger point patterns. Although nerves are involved, it’s quite different from a trapped nerve in the way it happens. That said, symptoms can be similar, with both sciatica and SIJ referred pain able to cause pain that can be dull, sharp, or shooting.
Where this topic crosses over with trigger points, the research is lacking. But referral patterns from organs causing pain in muscles and joints are well documented. As well as the heart referring to the arm and jaw, we know that the diaphragm can cause neck and shoulder pain, and the kidneys can cause lower back and thigh pain.
The Importance of Recognising Referred Pain
There are a number of conditions that involve this phenomenon. There are others that are incorrectly diagnosed, when in fact the problem is a simple referral. If we can avoid this misdiagnosis, we can treat the real root of the problem. Success here might mean preventing a trip back to the GP for persistent carpal tunnel syndrome, that results in ineffective surgery. For the visceral referrals mentioned above, we need to know when we truly are dealing with lower back pain, and when it might actually be a kidney infection. This is just another reason why we take a detailed case history, asking about all body systems, even if they seem irrelevant.
Some headaches are the result of trigger points and referrals from the neck. These are the kinds of headache that osteopaths are qualified to treat, so being able to recognise and diagnose them is key. Treatment for cervicogenic headaches depends on the exact cause, but often involves work to both the muscles and the joints.
Osteopathic Management
Your osteopath will try to diagnose the cause of the aches and pains you bring to clinic. Where symptoms are referred from elsewhere, we can screen to identify whether there is a problem with an organ, a nerve, or another muscle or joint. If the cause proves to be out of our remit, we will send you back to the GP with whatever information we can to support you in getting the treatment you need. Where the cause is something that we can treat, we will explain the process before commencing treatment. Pain is complicated, and the more you understand about your pain, the better your outcomes are likely to be. From here, we can commence treatment, which may involve hands-on treatment as well as exercise and advice.
If your pain has been ineffectively treated for a while, you might just find that a new therapist can help you get to the bottom of it. Should you suspect that your pain is referred, mention it at your first appointment with us.
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