Low back pain with referred
pain
This type of low back can also vary widely with
regards to severity and quality. It tends to
be achy, dull and migratory (moves around). It
tends to come and go and often varies in intensity.
It can result from the identical injury or problem
that causes simple axial back pain and is often
no more serious.
Area of pain distribution
Referred pain is usually felt in the low back
area and tends to radiate into the groin, buttock
and upper thigh. The pain often moves around, and
rarely radiates below the knee. This type of low
back pain is not as common as axial low back pain
or radicular pain (sciatica).
Referred pain is analogous to the pain that
radiates down the left arm during a heart attack.
It is the result of the extensive network of
interconnecting sensory nerves that supply many
of the tissues of the low back, pelvis and thigh.
An injury to any of these structures can cause
pain to radiate – or be “referred” -
to any of the other structures. It is important
to understand that this type of pain is not due
to “pinched nerves”.
Diagnosis of referred low back pain
Unfortunately, the brain cannot determine the
specific source of the pain. A careful history
and physical exam by an experienced spine specialist
can usually distinguish this type of pain from radicular
pain, or pain that radiates down the leg along
the specific course of a compressed spinal nerve.
The distinction between referred pain and radicular
pain is critical because the treatment of the two
types of pain varies considerably.
Treatment of referred low back pain
In general, referred pain is treated with the
same types of conservative care as axial back pain
and will frequently diminish as the low back problem
resolves. Once the possibility of a serious underlying
medical condition as the cause of a patient’s
low back pain is ruled out, treatment of referred
low back pain is conservative (non-surgical) and
may include one or a combination of the following:
- A short period of rest (e.g. one or two days)
- Physical therapy, active exercise and stretching
- Ice packs and/or hot pads
- Appropriate medications for pain relief
If the above treatments do not successfully
reduce the patient’s pain to a manageable
level, then additional non-surgical treatments
may be tried. Laminectomy and discectomy surgery
(back surgery aimed at decompressing the spinal
nerve sac or individual spinal nerve roots) is
often unsuccessful in treating referred pain.
For cases of chronic severe low back pain, with
or without referred leg pain, further testing
and evaluation with discography (injection of
the discs to determine if they are the pain generators)
may be considered depending upon the treatment
options being considered by the treating spinal
specialist. |
