Why Pain Might Not Be Where You Think It Is: Understanding Referred Pain

When we experience pain, our first instinct is to assume the source lies at the site of discomfort. Pain in the knee must mean a knee injury; shoulder pain must stem from the shoulder. But the body’s nervous system is far more complex. In many cases, the true origin of pain may lie elsewhere entirely. This phenomenon — known as referred pain — is a critical yet often overlooked concept in both conventional and integrative pain management

Referred pain is a type of pain perceived at a location other than the site of the painful stimulus. It occurs when pain signals from different parts of the body converge onto the same nerve pathways in the spinal cord and are misinterpreted by the brain.

For example, a person experiencing a heart attack may feel pain in the jaw, left arm, or upper back. This is not because those areas are injured, but because the heart and those regions share common spinal cord segments for sensory input.

The exact mechanisms behind referred pain are still under investigation, but several neurophysiological theories help explain it:

1. Convergence-Projection Theory

This is the most widely accepted explanation. Sensory neurons from different parts of the body converge on the same second-order neuron in the spinal cord. The brain, unable to distinguish the true source, “projects” the pain to a more familiar location.

2. Hilton’s Law
Hilton’s Law — referenced in Dr. Krasnick’s FAQ section — states that the nerves supplying a joint also innervate the muscles moving that joint and the skin covering the area. This anatomical overlap explains why dysfunction in one part (e.g., a joint) can manifest as pain in an adjacent region.

3. Central Sensitization
Chronic inflammation or nerve irritation may lead to central sensitization, where the nervous system becomes hyper-reactive. This can result in pain signals being misdirected or amplified, contributing to referred sensations.

Understanding referred pain patterns is essential for accurate diagnosis and treatment. Here are a few clinically relevant examples:

One of the biggest challenges in treating musculoskeletal and chronic pain is accurately identifying the source. Focusing solely on the site of pain can lead to misdiagnosis and ineffective treatment.

At Krasnick Regenerative Medicine, understanding the principles of referred pain plays a critical role in precision diagnostics. Dr. Krasnick uses tools like musculoskeletal ultrasound and a detailed physical examination to trace symptoms back to their origin — a process that’s often overlooked in conventional care settings.

For example, a patient presenting with persistent “tennis elbow” may actually have nerve entrapment originating in the cervical spine or shoulder girdle. Treating only the elbow would offer limited, if any, relief.

When pain is misidentified, conventional treatments such as corticosteroid injections or surgeries may target the wrong structure. Regenerative medicine provides a different path — one that focuses on restoring tissue function and resolving underlying dysfunction, rather than simply suppressing symptoms.
Depending on the diagnosis, treatments may include:

• Prolotherapy – to stimulate healing in joint or ligament tissues.
• Platelet-Rich Plasma (PRP) – to promote tissue regeneration at the root source.
• Neural Prolotherapy (Lyftogt Technique®) – to treat nerve inflammation along pain pathways.
• Nerve Hydrodissection – to relieve impinged nerves that may be contributing to referred symptoms.
• Shockwave Therapy (ESWT) – especially effective in cases of chronic tendinopathy associated with referred pain patterns.

These interventions are selected only after thorough evaluation — a core tenet of the clinic’s individualized, systems-based approach.

If you’ve experienced pain that:

• Shifts location without obvious cause
• Doesn’t respond to localized treatment
• Flares up with movement in other joints
• Feels “deep,” dull, or hard to describe

…it may be referred pain.

At that point, a more detailed biomechanical and neurological assessment is often warranted. The goal isn’t just to label the pain — but to understand its origin and mechanism.

Pain is complex — and it’s not always what it seems. Referred pain challenges the idea that discomfort is always local. Instead, it reminds us that the body is a dynamic, interconnected system. Misinterpreting referred pain can delay healing and lead to ineffective treatments. But with careful evaluation and an integrative mindset, referred pain can be both understood and effectively treated.

At Krasnick Regenerative Medicine, uncovering the root cause — not just chasing symptoms — is at the heart of everything we do.