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How to Locate the Source of Pain--Referred Pain

Sometimes it may not be so easy to tell where it hurts. The pain you may be experiencing in your ankle, for example, could be coming from a hip injury, or that tingling in your little finger can be the result of a torn rotator cuff.

Dr. Norman Harden, director of Center for Pain Studies Rehabilitation Institute of Chicago talks about experiencing pain at a location distant from the trigger point, or referred pain.

Pain can be maddening, even in its most benign form: that chronic headache you're suffering from may be coming from a neck muscle. But at its worst, the pain you may be feeling down your left arm, could be the signal for a heart attack.

People are generally not good at diagnosing the source of pain unless they know they've somehow injured themselves, and the pain they're feeling is the consequence of that injury. The pain message is critically important. It's a symptom that tells us something is wrong. But it's often misinterpreted.

In contrast with the sense of touch which gives a great deal of accurate information about location, intensity, and temperature, pain is vague and diffuse, especially when the message goes through the spine.

The visceral organs are by far the most difficult to locate in terms of pain. A damaged heart is the most dramatic example: when the blood flow is diminished, pain can be felt down the arm, in the jaw, even in the back. These are not discrete signals. Other viscera send diffused and confusing messages as well.

When to seek relief from pain

Depends on the intensity, duration and source and pain. If you know you've stubbed your toe, give it time to heal. If the pain in your toe is from no obvious cause and the pain is persistent and intense, then, seek treatment.

Though pain is the number one reason that people see doctors, only about 25% to 35% of people in severe pain, seek out a specialist. When you experience pain, you should first see a family practitioner or internal medicine physician. If you're not satisfied, ask for a second opinion, for example, from an orthopedic surgeon, or neurologist. But if that's not alleviating the pain, seek out a pain specialist--an algologist.

The different types of pain sources include: nerves, joints, muscles, bones, and visceral organs.



Overview of pain and how it is delivered

When the skin is touched, there is a great amount of information disseminated: place, intensity, heat or cold, lots of information is relayed. The pain response, though, just offers us a general impression but not much information about location, intensity, and even seriousness. Very little is known about how pain is processed in the brain. Nevertheless, we know that the braiis very active in processing pain. The pain system is pervasive and redundant in terms of impact on the nervous system but it is not very discrete. In other words, it's qualitative but not quantitative.

The pain message becomes triply vague in terms of localizing internal organs and they don't give a lot of information to the brain.

Take heart attacks for example, the more different areas that are involved in the heart attack, the broader the pain representation. If the upper left part of the heart has decreased blood flow, for example, the entire chest hurts. It also hurts down the arm into the jaw, and into the scapula. Heart attack may present symptoms: pain in left arm, left jaw as well as left chest pain. What's happening on a scientific level is that the most common nerves that feed the heart and the left arm converge in spinal cord in the same place, the neurons are sending impulses to brain.

Visceral organs are the least discrete in terms of pain. Almost always thpain will be referred to some external point.

Other common visceral problems and the cites of the pain

Liver: vague diffused abdominal pain

Aortic aneurysm: under the scapula in the back.

Lungs: burning, stinging sensation in the skin

Gall bladder: may feel pain near shoulder blade

Appendix: initially may feel pain around belly button, the skin over the right quadrant of the belly.

Reproductive organs: lower back




Other common trigger sites

Neck--May cause chronic pain in the head or constant headache

Neck pain can also radiate into shoulder. So something as simple as sleeping on the wrong pillow or in the wrong position, or holding a telephone between the shoulder and the neck can result in a chronic headache.

Buttocks pain traveling from the buttocks down the back of the leg is often commonly referred to as sciatic pain, but sciatic pain is a distinct nerve pain originating from the sciatic nerve which supplies the skin all the way down to the foot. When the muscle is tight, they have trigger points that go into spasm. Even doctors can be stumped.




How do you solve the problem

Do an ergonomic assessment and correction. Check the sitting arrangement, the positioning of workstation and sleep postures. Physical therapy is helpful at strengthening postural balancing. Also try heat therapies, and massage.

But you should go to your doctor if you experience chronic pain. It's a symptom that is trying to give the patient a message. It's either something treatable or must be identifiefor safety purposes. People cannot diagnose themselves.

Depends on the pain and the nature of the pain. If it is anything new, different, or scary, you need to see a doctor. It's better to be safe than sorry. Be very cautious of pain in the chest associated with sweating or shortness of breath. As for pain in your big toe, you can wait to see if it's going away.

Your doctor will walk through what's relevant and what's not. It's a part of the diagnostic process. You describe a minor headache in the left temple that gets worse when you bend over, those two symptoms are consistent with a brain tumor, which is different from "I am not sitting up right, or sitting on a lousy chair or I had MSG for dinner."

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