Unexplained Pain?

Making sense of your pain

How many times have you woken up in the past to find that you have a new ache or pain. Where does this pain come from?

The sensations we experience in our bodies are not random. The complexity of the human  body can make what we experience seem random.

When we experience pain in a muscle or around a joint, a common assumption is that the problem is right there with that muscle or joint. This may seem self evident but it’s not quite that simple. It could be referred pain. This is a pain that originates in one place but shows up in another.

For example a common presentation in the clinic is pain on the side of the neck and shoulder and down around the shoulder blade. Each joint in the neck has a distinct area of referred pain so patients are often surprised to find that the pain they feel in the shoulder blade is in fact from the neck and that joint problems at the top of the neck may cause tension headaches. See the diagram below by N. Bogduk

Each vertebrae in our spine has a corresponding spinal nerve, these can also give referred pain, as the diagram below shows. An example of spinal referred pain is sciatica which arises from the irritation of the spinal nerves at L4 and/or L5,S1.

Internal organs may also give referred pain. The sensory nerve supply for the heart originates from the spinal nerves at T1-4 in the upper back so the pain felt during a heart attack is in the left arm or shoulder. Pain in the right shoulder may also be referred from the liver and gallbladder

Referred pain is therefore something that needs to be considered in all patients complaining of any type of pain in order to make an accurate diagnosis. These referral patterns are something that osteopaths are highly trained in.