All About Referred Pain

Referred pain, also known as reflective pain, is used to describe pain that is perceived in an area different to its origin. An example of this is experiencing pain in the teeth or jaw during a heart attack, although this is an extreme circumstance and referred pain can occur in less drastic situations.

Pain referral is quite common in people who suffer from some sort of chronic musculoskeletal pain, like fibromyalgia, temporomandibular disorder (TMD) or even chronic lower back pain. It is important to understand when pain is being referred, as practitioners may carry out treatments they believe will relieve the pain but end up having no effect whatsoever, as they didn’t target the source of the pain.

How Does Referred Pain Occur

There is no clear cause of referred pain although it is thought to have a neural basis, with a neural phenomena called convergence being heavily involved in pain referral.

Information regarding touch and tissue damage are conveyed along sensory nerve fibres that have their receptors in different parts of the body. There are two different groups of nerve fibres that convey information, with one group conveying the touch information and the other conveying tissue damage and noxious stimulus information. Both groups of nerve fibres convey action potentials into the brainstem to terminate on second order neurons.

There are two important things that can happen in the brainstem when this happens:

♦  Many fibres that convey tissue damage and noxious stimulation from different parts of the orofacial area can terminate on the same set of second order neurons (nerve fibres from orofacial skin, teeth pulp and jaw muscles can all converge onto the same second order neuron)

♦  Both types of nerves can converge onto the same second order neuron

Despite the biological reason for convergence not being completely clear, it still appears to have at least some part in pain being referred. The second order neurons are part of the network that communicates sensory information to higher centres for perception. With an abundance of sensory information from various body parts on the same second order neurons, the neurons may start to provide vague information regarding the specific location of the noxious stimulus. This is just one way that referred pain is thought to occur, as the brain becomes confused as to where the noxious stimulus is actually is.

Treating Referred Pain

As referred pain is a specialised type of pain that is experienced in a location different to its origin, treating the source will alleviate the pain. There are various methods to help you cope with the pain while your doctor works to figure out the source of the pain, such as:

♦  Medicine

♦  Dry needling

♦  Stretching

♦  Massage

♦  Heat/ice pack application

Referred pain is still quite mysterious, with no definitive consensus on what causes it. With multiple theories on the mechanisms of referred pain, there are various pathways to take when identifying referred pain and its origin. This means that it can take a while to properly treat, in which you should use various coping methods to alleviate the pain temporarily.

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