When Pain Is Misleading

I once received a call from a very high level Olympic track and field athlete as he was preparing for the Olympic Games. He was a world record holder and seemed destined to come home with Gold. He told me that he thinks he may have "pulled a hamstring" although he did not recall any one event where the muscle was strained. He had a dull ache in the back of his thigh and was having difficulty running especially when he picked up his pace and try to lengthen his stride. He was concerned that he might not be able to compete at a championship level.

I was on the other side of the world and was unable to examine him directly. We talked further, and with further questioning it became pretty clear to me that this was not a hamstring pull but rather a problem with his lower back that included a mild form of sciatica resulting in referred pain to his thigh area. Not a good situation for him, at that point in his life.

Pain is an important signal that your body delivers when it senses that something is not right. It is a protective mechanism to let you know that there is a malfunction and to hopefully prevent you from doing further damage in some instances.

Sometimes pain is very straightforward. You hit your thumb with a hammer and it hurts. Other times pain can be deceptive. There are even situations in which a relatively minor pain related issue can be amplified by the brain, resulting in pain out of proportion with the cause. We are learning more and more about the many complexities of pain, but we have a long way to go.

One way that pain can deceive you is when you feel pain any location away from the primary source of the pain. This phenomenon is called "referred pain" and is relatively common. I see it almost every day in my office practice. Referred pain occurs because of the way our nervous system is wired. Signals can be sent from remote areas and are subject to interpretation by the brain.

Examples of referred pain include arm, shoulder, or shoulder blade pain from problems in the cervical spine or neck area. Buttock and leg pain are common with lumbar spine or low back issues. Certain hip disorders can send pain signals to the knee to the point where patients with these hip problems come into the office complaining of knee pain. Individuals with arm or leg amputations can still "feel" pain and other sensations in the amputated hand or foot, something referred to as "phantom pain." Heart attacks can present with left arm pain and not pain in the chest. Gallbladder attacks can start off with pain in the back even though your gallbladder is around front in the abdominal area. There are many more examples.

We are not certain from an evolutionary standpoint why pain signals are not always more direct in their presentation. This phenomenon can certainly keep those of us in the medical profession on our toes. This is why a very thorough history and physical examination is always important when someone presents with pain.

Unfortunately, my Olympic friend did not bring home a metal. At his level, if you are not functioning at 110%, you are all too often left behind.

In my next blog entry, I'll cover a few of the more common examples of "referred pain" so that you are not misled by your body. Have you experienced "referred pain" at any point? Please share your stories with us.

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