EMS Patient Assessment - Referred Pain (2)

Referred pain is a phenomenon where pain is perceived at a location different from the actual site of the underlying problem or injury. This occurs because the same nerve pathways that carry pain signals from one area of the body can overlap or converge with the nerve pathways from another area. 

As a result, when pain signals are generated in one region, they can be misinterpreted by the brain as originating from a different area that shares nerve connections.

Referred pain can be confusing because it can lead to the misdiagnosis of the source of pain.

Cardiac Referred Pain: One of the classic examples of referred pain is related to the heart. When the heart muscle (myocardium) is deprived of oxygen and nutrients, such as during a heart attack, the brain often interprets this pain as originating in the left side of the chest, left arm, or even the jaw.

- Levine's Sign: Named after Dr. Samuel Levine, this sign is related to cardiac referred pain. It's a characteristic clutching of the chest seen in patients experiencing angina or a heart attack.

Gallbladder Referred Pain: Gallbladder issues, like gallstones or cholecystitis, can cause referred pain to the right shoulder or between the shoulder blades. This is because the same nerves that supply the gallbladder also connect to these areas.

- Murphy's Sign: Named after Dr. John Benjamin Murphy, this sign is used to diagnose gallbladder-related pain. It involves the patient experiencing increased pain or discomfort when the doctor palpates the area beneath the ribcage on the right side during deep inspiration.

Spleen Referred Pain: Referred pain from the spleen typically presents as discomfort in the left upper abdominal quadrant, just beneath the ribcage. Conditions that can cause spleen-related referred pain include splenomegaly and conditions that lead to trauma or rupture of the spleen.

- Kehr's Sign: Named after Dr. Hans Kehr, this sign relates to pain in the left shoulder that can occur due to irritation of the diaphragm, often resulting from conditions like a ruptured spleen or other sources of abdominal bleeding. In such cases, Kehr's Sign is used to describe both the referred pain and its association with spleen-related issues.

Appendicitis: Inflammation of the appendix can often cause pain around the navel or the upper abdomen before it eventually migrates to the right lower quadrant, which is the classic location for appendicitis pain.

- McBurney's Point: Named after Dr. Charles McBurney, this is a location used to diagnose appendicitis, which corresponds to the location of the base of the appendix.

Kidney Stone Pain: Pain caused by kidney stones can be felt not only in the lower back and side, where the kidneys are located but also radiate down to the groin area or the abdomen.

- Costovertebral Angle (CVA) Tenderness: While not named after a specific individual, this is an important sign to check for when evaluating kidney-related pain, such as kidney stones. Tenderness in the CVA, located on the back, just below the ribcage, is indicative of renal issues.

Diaphragm Referred Pain: Irritation of the diaphragm muscle can cause pain in the shoulder, especially the left shoulder. This is because it shares nerve connections with the shoulder area.

Liver Referred Pain: Liver inflammation or congestion can lead to referred pain in the right shoulder or upper back due to the shared nerve pathways.

Understanding referred pain is important for healthcare professionals as it can sometimes make diagnosing the underlying condition more challenging. It's crucial to consider referred pain in the diagnostic process to identify and treat the actual source of the problem accurately.