Introduction
There are many different types of pain. Patients may describe their discomfort as sharp, stabbing, dull, or achy, for example. They may have constant pain, or it may come and go in an intermittent fashion. When taking the history of a chief complaint, questions about a patient's pain are very important and provide the DC with important clues about what could be happening well before the patient is even examined. We always ask patients, "Does the pain shoot or radiate to any other location?" In this article, we will discuss pain felt in areas away from the site of injury or insult to provide you with a better understanding of the topics of referred pain and radicular pain.
Referred Pain Defined
Simply stated, referred pain is when the pain you feel in one part of the body is actually caused by pain or injury in another part. Pain referral happens because nerves in the body are connected and share common pathways in the spine. With referred pain, patients may not be aware of the origin of the pain. A few examples of visceral (organ-based) referred pain include:
Heart: Teeth, jaw, down the left arm, could be referred from the heart muscle/heart attack.
Pancreas: Between the shoulder blades.
Gallbladder: Pain under the right scapula.
For amputees, phantom limb pain is a type of referred pain when the patient actually feels pain in the removed appendage. Even something as simple as "brain freeze" that we get after drinking a cold drink too fast or eating an ice cream is a form of referred pain. The pain stimulus is happening in the mouth and throat, but you feel the pain in the middle of the forehead or at the base of the skull. As a quick FYI, brain freeze can be lessened significantly by placing your tongue or something warm on the roof of your mouth. Why? Because the nerve causing the problem is located there!
Radiating Pain Defined
Radiating pain could be considered a type of referred pain. Patients will describe radiating pain as moving from one point to another. They may say something such as, "My neck hurts, and then it feels like it is shooting down my arm." Or, "My low back hurts, and it feels as if it's moving down the back of my leg, which feels heavy and tingly."
Radiating pain can have many qualities, with burning or electric being common descriptions. Radiating pain can also cause other sensations, including numbness, tingling, weakness, or heaviness, and can range from dull, aching, and difficult to localize to sharp and shooting. Patients may be able to trace the pain path with their finger. Radiating pain can come from the irritation of a specific nerve being compromised. The sciatic nerve, for example, will send a shooting pain down the back of the leg, but compression of a spinal nerve root exiting the spine could also cause larger patches of altered sensations, especially on the skin. These are called "dermatomes" and correlate directly with spinal nerve levels. For example, if a patient had altered sensations or numbness of the top of the arm and the thumb, I may immediately suspect the C6 spinal level has an issue to be examined. (See the accompanying image).
In the chiropractic office, your DC may run across either type of referred pain and make determinations if a patient needs a referral for visceral-based pain. However, most cases of referred pain seen in our offices will be radiating pain or dermatomal pain. These types of pain stem from irritation to spinal nerve roots and sometimes specific nerves. Irritation can occur because of conditions such as facet syndrome, herniated disc, spondylolisthesis, or compression syndromes in the thoracic outlet or extremities. For those types of pain, patients are in great hands in the chiropractic office, where they can receive adjustments to regain proper alignment, traction, or PT to relax muscle spasms that may be involved.
Ask your doc about continuing education! An understanding of anatomy and clinical applicability helps CAs better communicate with patients and provide care more safely. Discover coursework designed for CAs at www.cccaonline.com and use AMCHIRO as your discount code during the registration process to receive a $15 discount off the regular price of the program.
Laurie Mueller, BA, DC, CFMP, served in private practice in San Diego, California. She was the postgraduate director at Palmer College from 2000 to 2010; served as the ACC postgraduate subcommittee chair for six years; peer reviewed for the Research Agenda Conference, and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants (CCCAs). Dr. Mueller currently works as a private e-learning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, LLC, and subsidiaries CCCAonline.com and FxMedonline.com. She is a clinician, educator, and expert in online educational pedagogy.
