What is deep referred pain?

Deep referred pain is also called "scleratogenous" referred pain and is far more likely a cause of symptoms referring down a patient's arms or legs than is a true nerve root or "radicular" problem. We also call deep referred pain "somatic referred pain" where the "soma" or body tissues like muscles, bone, joint, ligaments, skin and fascia.

Once a trained clinician in the area of pain has ruled out central and peripheral nerve damage, their consideration of a patient's pain source causing referral should be that of joints, ligaments, or muscles. This is the most common scenario. The cause of this type of referred pain comes from our understanding of a patient's modulation of pain perception. There are several proposed theories for referred pain including:

1. pain signaling received at the spinal cord - this includes concepts such as the Convergent-Projection Theory, the Convergent-Facilitation Theory (AKA central sensitization), the Axon-Reflex Theory, and the Hyperexcitability Theory. In these cases pain can be perceived and inhibited or excited at the level of the backside of the spinal cord.  This can alter the pathway of pain that an individual feels in response in a painful stimulus.
2. pain signaling received in the brain - prevailing theories here include the Gate Control Theory, Central Modulation Theory and the Thalamic-Convergence Theory where pain can be modified by higher cortical centers in the  brain allowing for either inhibition or excited pain pathways to an individual's response to pain.

Examples of a patient's deep referred, "somatic" or "scleratogenous", referred pain that is most commonly seen with spinal related complaints could be from things like:

• Facet syndrome - joints of the spine are often called the facet joint. They may be injured by trauma, be that small or large, sustained postural loads, or simple activities of daily living that overload the facet load capacity. This can lead to pain inputs affecting some of the theories explained above, especially in chronic examples of facet syndrome. 
• Intervertebral disc injury - common causes of pain, especially in the region of the low back, is annular fiber tears of the intervertebral discs. This can occur even if there is no herniation into the spinal canal. Tears or local swelling can stimulate pain receptors in the spine and brain that, once again, can affect the theory of referred pain as explained above.
• Joint Dysfunction - because of their relationship to facets and discs, joints are considered capable of creating local and radiating symptoms similar to described above. Pain referral patterns in the thoracic spine and between the shoulder blades have often referred pain into the chest especially during activities in which the hands are held out in front of the body.
• Myofascial pain syndromes - trigger points can cause referred pain, numbness, or even paresthesia (a change in the normal sensation one feels in the skin) along the arm and legs. For instance, a common deep referred pain like this is seen in the shoulder. Trigger points in the rotator cuff muscles (e.g., supraspinatus, infraspinatus, subscapularis, and teres minor) can project pain into the arms.

Though describing the concept of deep referred pain as above may make it sound simple and easy to comprehend, the truth is that deep referred pain can overlap considerably with other clinical pain presentations and differentiation may be difficult. A way to remember "scleratogenous" pain is that it may be:

• Deep
• Dull
• Achy
• Hard to localize
• Diffuse

Want tips and tricks on getting rid of deep referred pain for good? Request an appointment now.
​

Request an appointment now!

Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.