Referred Pain

Definition and most reasonable theory :

Pain in a part other than that in which the cause that produced it is situated. Referred pain
usually originates in one of the visceral organs but is felt in the skin or sometimes in another
area deep inside the body. Referred pain probably occurs because pain signals from the
viscera travel along the same neural pathways used by pain signals from the skin. The person
perceives the pain but interprets it as having originated in the skin rather than in a deep-seated
visceral organ.
Definition;
Pain sensation occurs at exact pain stimulus which then radiates to other sites near the first
stimulated area.
Myocardial Infarction: Referred or Radiating pain ?
An example is the case of ischemia brought on by a myocardial infarction (heart attack),
where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the
injury. The pain related to a myocardial infarction could either be referred pain or pain
radiating from the chest. Classically the pain associated with a myocardial infarction is
located in the mid or left side of the chest where the heart is actually located. The pain can
radiate to the left side of the jaw and into the left arm. If so ; This is Radiating pain
Referred pain is when the pain is located away from or adjacent to the organ involved.
Referred pain would be when a person has pain only in their jaw or left arm, but not in the
chest. Myocardial infarction can rarely present as referred pain and this usually occurs in
people with diabetes or older age. If so; This is Referred pain

Theories for Referred Pain

There are several proposed mechanisms for referred pain

Convergent-projection

believed that the internal organs were insensitive to stimuli. Furthermore, non-nociceptive
afferent inputs to the spinal cord created what termed "an irritable focus". This focus
caused some stimuli to be perceived as referred pain. An example of that ; are nerves
from damaged heart tissue which convey pain signals to spinal cord levels T1-T4
on the left side , which happen to be the same levels that receive sensation from
the left side of the chest and part of the left arm. The brain isnt used to receive
such strong signals from the heart , so it interprets them as pain in the chest &
left arm.

Axon-reflex

Axon reflex suggests that the afferent fiber is bifurcated before connecting to the dorsal horn.
Bifurcated fibers do exist in muscle, skin, and intervertebral discs. Yet these particular
neurons are rare and are not representative of the whole body. But Axon-Reflex also does not explain the
time delay before the appearance of referred pain, threshold differences for stimulating local and referred pain,
and somatosensory sensibility changes in the area of referred pain.

Hyperexcitability
HyperexcitabilityStimuli is transmitted to the corresponding ganglia Nerves which share the same ganglion
are stimulated Pain Stimuli is transmitted to these nerve fibers Pain is felt on fields supplied by those
nerves.
No summation takes place

Thalamic-convergence

Thalamic convergence suggests that referred pain is perceived as such due to the summation of neural inputs in
the brain, as opposed to the spinal cord, from the injured area and the referred area.
nearly the same mechanism as Hyperexcitability but with summation of peripheral stimuli.

Referred pain( felt on)

Source of pain

Upper chest/left limb ; restricted feeling, or as an

ache in the left shoulder, arm or even hand
Head
Ice-cream headache or brain freeze
Right tip ofscapula.

Myocardial ischaemia

Left shoulder

Thoracic diaphragm, Spleen, Lung

Back

Pancreas

in which the vagus nerve or the trigeminal nerve in the throat and
the palate, respectively, transmit pain signals
Liver, gallbladder