Understanding Referred Pain vs Nerve Pain

26 Feb

Pain that travels away from its source can be confusing. Your back might be the problem, but you feel it in your leg. Your neck might be the culprit, but your arm is what hurts.

Two different mechanisms can cause this pattern. Referred pain spreads from structures like joints, discs, and muscles without involving nerves directly. Radicular pain comes from irritation of the nerve root itself. The distinction matters because treatment approaches differ.

General information only. Symptoms vary and diagnosis requires assessment by a qualified health professional.

What Is Referred Pain

Referred pain occurs when pain-producing structures in the spine send signals that spread into the limbs. Facet joints, intervertebral discs, muscles, and sacroiliac joints can all refer pain without any nerve root irritation occurring.

The mechanism involves how sensory nerves converge in the spinal cord. Different tissues share nerve pathways, so when one structure is irritated, the brain can misinterpret where the signal originated. Classic example: heart problems referring to pain in the left arm and jaw.

Referred pain from the lumbar spine commonly spreads into the buttocks and thighs. It tends to be dull, aching, or gnawing rather than sharp. The area is often difficult to pinpoint precisely. Importantly, referred pain does not follow a dermatome pattern and typically stays above the knee.

What Is Radicular Pain

Radicular pain is different. It results from irritation or inflammation of the nerve root itself, most commonly caused by disc herniation. According to research from Professor Nikolai Bogduk published in the journal Pain, radicular pain travels along the limb in a relatively narrow band, typically 5-8cm wide.

The quality differs too. People often describe it as sharp, shooting, piercing, or like an electric shock. Sciatica symptoms are a common example, where patterns of nerve pain in the leg follow the sciatic nerve distribution from buttock through the posterior thigh, sometimes reaching the calf and foot. Our blog on sciatica vs hamstring pain covers this distinction in more detail.

Cervical radiculopathy arm pain follows similar principles in the upper limb. A herniated disc in the neck can cause sharp pain, pins and needles, or numbness travelling into the shoulder, arm, or hand along a specific nerve pathway.

When Nerve Compression Causes Neurological Changes

Radiculopathy symptoms go beyond pain. When a nerve is compressed enough to affect its function, you may notice numbness in specific areas, weakness in certain muscles, or changes in reflexes. Some people have shooting pain with these signs. Others develop numbness or weakness with surprisingly little pain.

How to Tell Referred Pain from Nerve Pain

How to tell referred pain from nerve pain? A few features help distinguish them.

Referred pain tends to be dull, aching, and hard to pinpoint. It spreads into broad areas and typically stays above the knee or elbow. No tingling, numbness, or weakness.

Radicular pain is sharper and travels in a narrower band. It follows a dermatome pattern (the dermatomes map shows which nerve supplies which skin area). It can extend past the knee or elbow and may include pins and needles, numbness, or weakness.

Does nerve pain come and go? Both types can fluctuate. Radicular pain often worsens with sitting or bending. For some people, symptoms settle over time as inflammation reduces, though individual timelines and outcomes vary.

When Pain Becomes More Complex

Sometimes pain persists or spreads beyond what the original injury would explain. Central sensitisation is when the nervous system becomes hypersensitive, amplifying pain signals even after tissues have healed. Pain may spread to wider areas, touch or pressure becomes uncomfortable, and symptoms seem out of proportion to any identifiable cause. This doesn't mean the pain isn't real. It means the nervous system has become overprotective.

When Nerve Pain Requires Urgent Assessment

When nerve pain is serious, certain symptoms warrant prompt medical review. Progressive weakness in the limbs, difficulty with bladder or bowel control, and numbness in the saddle area (buttocks, genitals, inner thighs) can indicate cauda equina syndrome and require emergency assessment.

Bilateral symptoms affecting both arms or both legs simultaneously also warrant prompt review, particularly if coordination or balance is changing.

Physiotherapy Assessment in Adelaide

Ducker Physio provides assessment for referred and radicular pain presentations at both Adelaide locations. Whether you're searching for nerve pain physio in Adelaide, sciatica assessment in Magill, or nerve compression treatment in Salisbury, both clinics provide the same assessment. Neural mobilisation is one approach that may be considered for some presentations.

Assessment looks at your symptoms, strength, sensation, reflexes, and movement to help understand what may be contributing and whether physiotherapy may be appropriate. Physiotherapy isn't suitable for all presentations, and individual responses to treatment vary.

No GP referral is required. Book an appointment at the most convenient clinic.

Ducker Physio Magill

465/467 The Parade, Magill SA 5072

Phone: 08 7092 5962

Ducker Physio Salisbury

9 Mary Street, Salisbury SA 5108

Phone: 08 7092 5964

General information only. Individual symptoms and appropriate treatment vary. If you experience red flag symptoms including severe weakness, bladder or bowel changes, or saddle area numbness, seek emergency medical attention.Frequently Asked Questions