Ask Dr. Guerrero: What Is Referred Pain?

Learn what referred pain is, and when it requires prompt evaluation by a spine specialist.

referred pain

Do you feel shooting pain moving down your leg during a stroll along one of our beautiful Twin Cities walking paths? Have you noticed an uncomfortable tingling in your arm and hand while getting your steps in at the Mall of America? What you feel could be referred pain. We turn to fellowship-trained spine surgeon Dr. Roman Guerrero to better understand this pain and how it happens. He describes the symptoms of referred pain and explains some of the conditions that cause this discomfort.

Referred pain versus primary pain

Before explaining what referred pain is, Dr. Guerrero distinguishes it from primary pain. “Understanding these two types of pain is all about identifying the source of the pain,” he explains. “If you bang your elbow and immediately feel pain in your elbow at the point of injury, that’s primary pain. On the other hand, arm or leg pain that is deep or diffuse without an easily identifiable source is more likely to be referred pain.”

Where do we feel referred pain?

This pain is typically felt deep in muscles, joints, ligaments, and tendons. It is called “referred” because this pain doesn’t occur at the point of injury. Instead, it is felt in a part of the body farther away from the actual injury. In the upper body, it may be felt in the neck and shoulder with shooting pain that goes all the way down the arms into the hands. In the lower body, nerve-generated pain can be experienced as a shooting pain running through the buttocks and thighs. Also, in some cases, the discomfort runs all the way down the legs and into the toes.

How does referred pain happen?

Most occurrences of referred pain are caused by nerve conditions. “Frequently, the pain is caused by nerve disease or a nerve root impingement somewhere along the spine,” explains Dr. Guerrero. “The pain generated by the nerve injury travels through our upper or lower extremities.

“Several conditions can cause intrinsic nerve root damage,” says Dr. Guerrero. “Most commonly, the culprit is nerve impingement, or peripheral nerve pathology. Impingement can occur at any point along the cervical, thoracic, or lumbar spine where the nerve exits the spine. In most cases, the problem is in either the neck or the lumbar spine. We have to identify exactly where the nerve is impinged so that we can free it and provide pain relief.”

What does referred pain feel like?

This pain is commonly described as a shooting, burning sensation. But impinged nerves can also cause numbness or pins-and-needles sensation. “Numbness and tingling aren’t necessarily painful,” notes Dr. Guerrero. “But my patients describe these sensations as weird, annoying, and disturbing.” He advises people to have pain symptoms evaluated, especially if it’s a shooting or burning pain or numbness and tingling.

How serious are conditions that cause referred pain?

“Pain is normal as we age,” states Dr. Guerrero. “Older patients can expect to feel some pain, but certain kinds of pain are a cause for concern. If a 25-year-old experiences shooting pain down the arm, that’s not normal.” Dr. Guerrero lists specific “red flag” symptoms that should be diagnosed and treated sooner rather than later.

  • Nighttime pain. “If the pain comes at night and wakes you up, that’s a red flag,” he says.
  • Intense pain. If the pain is out of proportion, meaning you’d rate it a 7 or higher on a 1 to 10 pain scale, you should be evaluated.
  • Tingling in the thighs. “When you feel numbness or tingling that runs down your inner thighs, you have to be diagnosed as soon as possible,” Dr. Guerrero notes.
  • Pain accompanied by weakness. “If pain is accompanied by weakness in your hands or muscles,” says Dr. Guerrero, “you should be seen by a spine specialist to further diagnose what’s going on. This is especially true if there’s motor weakness — you feel that you are not able to grab or lift things, or you experience difficulty moving your legs to stand or walk.”
  • Pain accompanied by bowel or bladder incontinence requires immediate medical evaluation.

“Any of these symptoms should be evaluated as soon as possible,” advised Dr. Guerrero. “They can be treated effectively, but only if they are treated quickly. When you experience unbearable pain, pain that wakes you up in the night, or noticeable weakness, you have to be very cautious.

Risks associated with referred pain

“There are serious risks in ignoring the red flag types of pain we’ve described,” says Dr. Guerrero. “You could permanently lose nerve function. If it gets to the point where there’s an unbearable pain or these other risk factors, don’t delay medical evaluation. It is particularly important if there’s motor weakness of your muscles and you feel that you are not able to grab or lift things, move your leg to stand or walk, experience incontinence issues, or feel numbness or tingling down your inner thighs. Without treatment for these symptoms, you could definitely lose nerve function. That means no recovery of your muscle strength.”

Dr. Guerrero’s tip for evaluating referred pain

“I tell patients to consider how their pain affects their quality of life,” says Dr. Guerrero. “If the pain isn’t bothering you or affecting your daily life, you may want to discuss it with your primary care physician. But if it gets to the point that it’s affecting your quality of life even at a minimum, come and see me. That type of pain should be evaluated by a spine specialist, because there’s usually a culprit. You shouldn’t be held prisoner by pain. We want to figure out the pain source, so we can treat it effectively and get you back on track.”

Summit Orthopedics offers comprehensive spine expertise

Summit Orthopedics’ Spine Care program is recognized by the National Committee for Quality Assurance for the comprehensive expertise of our patient-centered care. Our back specialists diagnose spine problems and design custom treatment plans built on a conservative, nonsurgical approach. Most patients find relief through treatments including guided injections, specialized physical therapy, biofeedback, exercise, activity modification, and medication. When conservative care does not relieve symptoms, our highly skilled surgeons offer proven, evidence-based surgical options. Together with you, we will determine the right course of action.

Start your journey to a healthy spine. Find your spine expert, request an appointment online, or call us at (651) 968–5201 to schedule a spine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MNPlymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

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  • Roman G. Guerrero, M.D.

    “Pain arising from the spine can have a wide presentation, sometimes is back or neck pain and on occasions it exhibits as referred pain to the arms and legs.  I believe in treating a patient and not its symptoms; individual circumstances needs empathetic, evidence based specialized care.”

    More about this expert

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