Do you have a niggling back problem that won’t go away? This is the little-known disease it could be hiding. Read our ultimate guide to deferred pain – and the aches you can’t ignore

Why do you get a headache when you eat something cold? Is it true that having a heart attack can cause arm pain?

The key to both is referred pain; The feeling of feeling pain in one part of the body when it is actually caused by a problem in another area.

‘Referred pain often occurs because the brain ‘crosswires’ when it detects pain,’ explains Kirsty Bannister, associate professor of pain neuroscience at Imperial College London and spokesperson for the British Pain Society.

‘Pain is not perceived at the site of injury; “The perception of pain is produced in the brain,” he says.

When you experience some type of injury, nerve fibers carry pain signals from the area to the brain via 30 different points in the spinal cord. “It is the level of the spinal cord from which the signal originates that determines where the brain perceives pain,” says Professor Bannister.

‘The problem is that multiple different body parts ‘talk’ to the brain through the same specific point in the spinal cord. Signals can get confused, which means the brain may misunderstand where the injury actually is.

Professor Bannister explains: ‘For example, each of the internal organs will correspond to a particular spinal level; ‘this may also correspond to where in the spinal cord the input from your arm is mapped’.

‘For example, if there is trauma to the skin, it is easy to distinguish the origin of the pain,’ he says.

‘But in the case of referred pain, the brain misinterprets its location and the area of ​​referred pain may actually be healthy.

Professor Bannister adds: ‘Referred pain can in some ways save your life; “This tells you there’s something wrong with your body that you might not otherwise be aware of,” he adds.

But Dr, a pain management consultant at the Royal Free London NHS Foundation Trust and Wellington Hospital in London, says: Referred pain can also delay diagnosis, says Aditi Ghei.

‘Finding the root of the problem can be difficult because the pain mentioned does not stop clearly,’ he says.

Professor Bannister adds that this is usually due to our internal organs because they are not as covered with sensory fibers as our skin. ‘This means there aren’t enough fibers to detect and send pain signals to the spinal cord when something bad is happening to an internal organ,’ he says.

However, because the brain receives most sensory information from the skin, if nerves from internal organs are activated due to an injury or problem, the brain incorrectly perceives this signal as coming from the skin.

“In many cases we don’t know where the pain is coming from, so doctors have to be careful that it could be caused by pain,” says Jan Vollert, lecturer in pain medicine at the University of Exeter and Imperial College London.

If you’ve had unexplained pain for three months or more, ‘press for an investigation to understand what the pain is and where it’s coming from,’ Professor Bannister adds.

Jan Vollert says some people are more prone to pain than others, including people with diabetes (which can cause nerve damage) or those who have had chemotherapy (which can also damage nerve cells).

‘It also becomes more common as we get older because our nervous system becomes less efficient.’

Here, we uncover signs that you may be experiencing referred pain.

Headaches can be caused by nerve compression in the neck or neck arthritis, says Professor Bannister

Headache

It may be caused by a problem in: neck, mouth

Professor Bannister says headaches are a ‘classic example of referred pain’ and can be caused by nerve compression in the neck or neck arthritis. ‘A pinched nerve or stiff neck can cause a headache because pain signals radiate and travel towards the cervical spine. [the area of spine around your neck] to the rest of your head. ‘The brain misinterprets neck pain as a headache because all head and neck pain signals pass through the same point on the cervical spinal cord, which can confuse the brain.’

By the way, the ‘brain freeze’ feeling is actually pain coming from the mouth. This is because cold receptors in the mouth connect with nerve cells in the cervical spinal cord. ‘It is thought that it is not clear to the brain exactly where these originate, thus causing a headache-like pain,’ says Dr Ghei.

face/chin

There may be a problem: neck

Professor Bannister explains that nerves from the cervical spine, jaw and temporomandibular joint (TMJ, which connects the jaw and skull) feed to the same point on the spinal cord, so tension in the neck (e.g. from poor posture) can cause referred pain in the face, jaw or ear. ‘Sometimes, a patient goes to the dentist with mouth or jaw pain but has a healthy mouth and teeth,’ adds Dr Ghei. This could be pain originating from the TMJ or cervical spine, he says.

Professor Bannister explains that the ear shares sensory nerve pathways with the jaw and teeth

ears

There may be a problem: teeth, neck

‘Because the ear shares sensory nerve pathways with the jaw and teeth, problems such as toothache, inflammation or loose filling resulting from gum disease in these areas can present as an earache even though the ear is healthy,’ explains Professor Bannister. Earache can also be linked to neck problems (see above). Dr Ghei adds: ‘If the ear is found to appear healthy on medical examination, further investigation with a specialist may be necessary in cases of earache.’

Arm

There may be a problem with: heart

While most people experience a heart attack as severe, crushing chest pain, some experience pain in their left arm. Professor Bannister explains: ‘This is because the sensory fibers surrounding the heart and the sensory fibers carrying pain signals from the left arm meet at the same level as the spinal cord.’ Dr Ghei says the point where nerve signals from the jaw connect to the spinal cord is the same as the heart, which explains why jaw pain can be another symptom of a heart attack.

Signals from the kidneys meet in the same part of the spinal cord (lumbar (or lower) spine) as the nerves from the lower back.

Back

There may be a problem: kidneys, pancreas, uterus

Signals from the kidneys meet in the same part of the spinal cord (in the lumbar (or lower) spine) as the nerves from the lower back. So, for example, a kidney infection can cause pain felt in the lower back.

Kidney stones can also cause lower back pain; These are usually diagnosed through a combination of urine analysis, blood tests, and scans.

Dr Ghei says the feeling of pain in the back may provide clues as to where it’s coming from. ‘If the pain originates from an organ within the body, it is more likely to be a dull ache, whereas if it originates in the lumbar spine it may feel like a sharp or burning pain.’

Pancreas-related problems such as pancreatitis (inflammation of the pancreas) can cause mid-back pain, says Ivan Ramos-Galvez, consultant pain medicine at the Royal Berkshire Hospital in Reading.

This is because the pancreas is located in the back of the abdomen, and nerve signals from the mid-back and pancreas meet at the same level as the spinal cord. Professor Bannister says even menstrual pain can be thought of as referred pain.

Signals from the pelvic area go to the same level of the lumbar spine as the uterus, and because the uterus is not lined with as many sensory nerves, she explains, women can feel pelvic pain in a very widespread way, rather than localized, as the uterus contracts, shedding its lining.

For the same reason, pain caused by uterine contraction can also be felt in the lower back.

But Dr Ghei explains that most of the time, back pain is caused by back problems, with only 5 percent of cases being due to pain.

Trauma to the spine can cause pain in the back or upper abdomen

upper stomach

There may be a problem with the spine

Dr Ramos-Galvez says irritation, wear and tear or trauma to the facet joints (small joints in the spine) of the vertebrae in the middle of the spine or the joints between the vertebrae and the ribs ‘can cause pain in the back or upper abdomen’. He explains: ‘This is because the ribs move up and down and at the same time the ribs come out at the back of the spine, go around the chest wall and end at the front. ‘Another sign is that you feel pain in the front when you press on your back or simply lifting a heavy bag or taking a deep breath causes pain in the back along with a pain in the front of your abdomen,’ he adds.

Pain in the groin may actually be due to inflammation caused by wear and tear of the sacroiliac joints, which connect the base of the spine to the pelvis.

Spoon

There may be a problem: lower back, hips

Pain in the groin may actually be caused by inflammation caused by wear and tear on the sacroiliac joints, which connect the base of the spine to the pelvis, says Dr Ramos-Galvez. Low back pain that increases with sitting and walking uphill, or groin pain, especially when sitting, are typical features of this. Unlike pain originating from the groin (such as muscle strains), groin pain originating from the sacroiliac joint does not cause tenderness or pain when pressure is applied to the groin.

In addition to sharing nerve pathways with the sacroiliac joint, the groin communicates with the brain through the same point on the spinal cord as our hips. This means that problems with the hip joint, such as wear and tear of cartilage, also known as osteoarthritis, can be felt as pain in the front of the groin.

Legs

There may be a problem: lower back, ovaries, appendix

Professor Bannister says sciatica – pain caused by irritation or compression of the sciatic nerve, which runs from the lower back to the foot – can cause a ‘red hot poker’ sensation in the back of the leg due to referred pain from the lower spine. It may occur in one or both legs, depending on the direction of the compression.

Working at the London Pain Clinic, Dr. Ramos-Galvez adds that the exact location of the pain depends on which disc is affected and which nerve root is damaged. ‘For example, pain in the front of the shins or in the feet may be a result of pressure on the lower part of the lumbar spine.’

Professor Bannister says upper spinal back problems can also cause sciatica, but this is less common than being caused by lumbar nerve problems. ‘Neck problems such as cord compression (due to a tumor or herniated disc) can cause radiating pain down the legs.’

Dr Ramos-Galvez explains that upper thigh pain can indicate problems with the ovaries or appendix. ‘The inflammation that comes with appendicitis or an ovarian cyst, for example, will irritate the muscles that run from the spine to the upper thigh.’ Dr. Ramos-Galvez adds that there will often be other signs that point to an abdominal problem: ‘For example, feeling pain when pressing on the abdomen.’