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Referred Pain Can Be A Pain In The Neck

Guest Editorial by Chandler Collins, DC
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How many times have you woken up some morning in the not-too-distant past to find that you have a new ache or pain? Trouble turning your neck. Pain around your shoulder blade. An uncomfortable lower back.

Where does this pain come from? Did you "sleep wrong"? Was the bed too hard? Too soft? Why, of all mornings, is it bothering you on this one?

The sensations we have in our bodies are not random. The perhaps unimaginable complexity of the human system can make what we experience seem random. But just because the pattern is too difficult for us to figure out doesn't mean that there isn't one.

So when we wake up with pain in a muscle, a common assumption is that the problem is right there with that muscle. This may seem self-evident, but it's not quite so easy. Let me explain.

If your phone keeps ringing over and over from an annoying prank caller, the "symptom" you experience is your discomfort from the phone constantly ringing, disturbing your peace. The problem doesn't start with the phone, though. It started with the prank caller on the other end of the line.

Bodies have a similar mechanism, where a problem in one area can send a signal that shows up elsewhere.

Take heart attacks, for example. You might have heard that a common symptom experienced during a heart attack is pain in your chest that can spread into your left arm and shoulder.

What does your arm and shoulder have to do with your heart? Not much, except that they share part of their nerve supply from similar levels in your spinal cord.

A common explanation for the shoulder and arm pain experienced by heart attack sufferers is that your brain misinterprets the flood of information it receives from an organ in trouble.

Instead of having us perceive this influx of information as a problem with the organ itself, our brains interpret the signals as pain and discomfort in a part of our bodies that are much more accustomed to those sensations. This kind of discomfort is called referred pain, since the pain is originating one place, but showing up in another.

What makes things interesting is that just about every organ we have seems to have a referred pain pattern.

You might have gotten up one morning, for example, with a "crick in your neck". Pain into one side of the neck -- typically, but not always, the right side -- that might radiate down around your shoulder blade.

Patients come in from time to time with this kind of pain. The usual explanation goes something like, "Well, I must have slept wrong or something." In many cases they're surprised to find out that the source of their pain has little to do with how they slept, and a lot to do with their gall bladder!

The gall bladder has a referred pain area that usually covers the right side of the neck and shoulder, down around the shoulder blade. As such we have to rule out gall bladder trouble as a source of their pain anytime a patient presents with this kind of pattern.

It's likely that the crick in your neck is more highly correlated with what you ate the night before than the position in which you happened to fall asleep. Fatty foods, spicy foods, or foods to which you may be allergic can frequently irritate the gall bladder.

After a good physical exam, if gall bladder irritation turns out to be the source of the problem, I have to advise the patient to avoid re-irritating the area with the foods mentioned above. Bile salts and pancreatic enzymes can also be helpful to reduce the load on the gall bladder while it recovers from the episode.

In short, if pain around the shoulder and neck turns out to be referred from the gall bladder, no amount of soft-tissue work will resolve the problem alone.

Since most organs appear to have a referred pain pattern, the gall bladder example used above is just one scenario where a visceral, or organ-related, source must be considered for what might appear to be a structural problem.

Seemingly structural problems can have visceral components. Likewise, a structural problem can have a very direct impact on our organ function.

The job of a truly holistic practitioner is to evaluate all facets of your well-being to help you improve your complete health.

Dr. Collins practices Chiropractic and Applied Kinesiology in Austin, TX. He is one of my best friends in the world.