What is Referred Pain and How Does It Work?

  • What is Referred Pain?
    • Referred pain is when a painful stimulus originating in one location is felt in a completely different area.
  • This referred pain can be originating from an organ or from a muscle (i.e. a trigger point)
    • Some common organ referral patterns are:
      • Heart: Felt at left shoulder and mid-scaps
      • Gallbladder: Felt at right shoulder
      • Kidney: Felt at low back / flank
    • Some common muscle ones (for the piriformis and trapezius muscles), thoroughly researched from work done by Travell and Simons, are demonstrated in the pictures below.
      • The X is the trigger point location, while the dots are where the pain is most commonly felt when pressure is applied to it.

Piriformis referral

Trapezius referral pattern






  • How can pain originating in one place be felt somewhere else?
    • The main theory is that different sensory fibers converge at the same level of the spinal cord and are processed in the same spot at the receiving end – the brain(stem). So, a painful stimulus originating in one area (let’s say the heart) will converge with sensory fibers from another area (the left shoulder) and the pain will be perceived as coming from, and therefore felt, at the left shoulder.
    • Although this is generally the most accepted theory, there are some other theories that have been developed to explain this as well (see hyperexcitability and axon-reflex theories).
  • Clinical Importance
    • From a clinical standpoint, it’s important to determine if the pain being felt by the patient is a referred pain or not! One excellent quote summarizes a lot of musculoskeletal complaints: “It’s the victim who cries out, not the criminal”.

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Written by Dr. Brandon Buchla, DC, CSCS

Check us out at www.atpplusct.com

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