Referred pain is a term that is used to describe pain that arises from one part of the body (usually an organ) but is felt in another. The way in which referred pain is caused is unknown, however there are several theories. The theories can get quite technical so I’ll be brief in mentioning one general theory and then discuss some common clinical signs and symptoms.

One thought is that the central nervous system “gets confused” when pain signals arising from the nerves of an organ enter the spinal cord at the same spinal cord level where somatic (or body wall) nerves enter. So even though the pain signal is being sent from an organ, the central nervous system perceives the pain as coming from the body wall.

The most common presentation of referred pain that you may be familiar with is pain in the neck, left shoulder and left arm when it’s really arising from the heart.

Other common referred pain patterns include:

• pain in the right shoulder, scapula (shoulder blade) and possibly the right side of the neck arising from the gallbladder

• low back pain (or flank pain) that really arises from the kidney (usually an infection)

• low back pain that may wrap around to the groin area when it is really from the ureter, the tube that carries urine from the kidney (usually a kidney stone)

• pain between the shoulder blades that is actually coming from the stomach

• pain in the “belly button” when it is really the appendix

I’d like to share a few other “referred” pain patterns that I see fairly frequently. These patterns may not be taking place for the same (neurological) reasons the examples described above do, but they certainly exist.

The first is sharp, local pain at the junction of the fourth rib and fourth thoracic (or mid-back) vertebrae. Sometimes the patient will also report that the pain seems to travel in a “straight line” through to the front of the body. Usually the fourth rib is “out of place” and needs adjusting. However, simply adjusting the rib and not addressing the underlying, true cause in this case is fruitless. Functional (i.e.: not pathological) gallbladder dysfunction needs to be dealt with. This can be the result dietary habits affecting the gallbladder and/or nutrient deficiencies related to the smooth flow of bile. Right-sided neck pain that connects to that area as if there is a band of muscle tension can also occur. This patient may have eaten a rich, fatty meal the night before and then wake up with pain, thinking that they “slept wrong”.

The other common pattern is when there is left-sided, mid-back and neck pain (again, often “connecting”) that is due to an issue arising from the stomach. Very often this is thought to occur because of toxic bile refluxing up the small intestine and into the stomach causing irritation. Addressing digestion and the reason(s) for liver toxicity is usually necessary. Keep in mind that even though these pain patterns exist from organ imbalances; the muscles, joints, etc. need to be restored to proper functioning through manual techniques.

One last thing, referred pain patterns can come from spinal joint and ligament dysfunction. And it can also arise from trigger points (or “knots”) in muscles. This phenomenon was discovered by John F. Kennedy’s doctor, Dr. Janet Travell. I’ll write about this in a separate article.

As George J. Goodheart Jr., DC, DIBAK would say (the late, great founder of applied kinesiology): “the body is intricately simple, and simply intricate”.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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