Where Is My Pain Coming From?

Have you heard of the term referred pain? Many people have heard of associating left shoulder and arm pain with a potential heart attack. Did you know the lungs or diaphragm could be a source of left shoulder pain as well?(2) How do we know what our pain means and does every organ have a place on the body in which pain can refer to? The concept of referred pain is important for medical professionals to understand thoroughly to help patients comprehend and to know when it’s appropriate to refer patients to other medical providers when needed.

Referred pain can be defined as "pain experienced at a site distant to the tissue damage".(1) It occurs because multiple sensory nerve cells converge on a single tract in the spinal cord for processing. Each organ of the body has a typical referral site that can be illustrated by the figure below:

So how do we know if the pain experienced is a structural, musculoskeletal dysfunction or an underlying organ dysfunction? Physical therapists and other medical professionals complete thorough evaluations to assess the source of pain. A physical therapy will perform a thorough subjective questioning about the onset of pain, discuss medical history of the patient, and collect all pertinent information on the pain. If the familiar pain is not reproduced by movement or the examination of the area of complaint, the patient may be referred to other providers as necessary. If the pain is reproduced within the evaluation and contributing structures are identified, it is highly unlikely that the symptoms originate from organ referral. Remember to always talk to your physical therapist and other medical professionals if you have any concerns or questions.

 References:

1. Walsh RM, Sadowski GE. Systemic Disease Mimicking Musculoskeletal Dysfunction: A Case Report Involving Referred Shoulder Pain. Journal of Orthopaedic & Sports Physical Therapy. 2001;31(12):696-701. doi:https://doi.org/10.2519/jospt.2001.31.12.696 
2. Ott K, Iwanaga J, Dumont AS, Loukas M, Tubbs RS. Postprandial Referred Shoulder Pain: A Case Report. Cureus. Published online May 31, 2022. doi:https://doi.org/10.7759/cureus.25535