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. An exaggerated example is your thumb being broken, but you feel the pain in your shoulder. This referred pain can originate from an organ, or from a muscle (called a trigger point).

Some common organ referral patterns are:

    • Gallbladder: Felt at right shoulder
    • Kidney: Felt at low back / flank
    • Heart: Felt at left shoulder and mid-scaps

Some muscle referral patterns are demonstrated in the pictures below (for 2 extremely common ones, the piriformis and trapezius).

      • The X is the origin of pain, while the dots are where the pain is most commonly felt when pressure is applied to it.

Piriformis referral pattern

Trapezius referral pattern






How does it work?

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. All pain is in the brain!

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. This can guide treating the cause and not the symptoms. One excellent quote summarizes a lot of musculoskeletal complaints: ““It’s the victim who cries out, not the criminal.”

For more information on trigger points, check out the work done by Travell and Simons, who thoroughly researched the topic and literally wrote the book on it.




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Written by Dr. Brandon Buchla, DC, CSCS

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