Referred Pain and Osteoarthritis
My groin hurts and my doctor told me I have hip arthritis. My hip doesn’t hurt, how can my doctor be right?
Sometimes we experience pain in a part of the body that is not the actually causing the pain. This is called referred pain and it is quite common. For example, you may have heard that a sign of an impending heart attack can be shoulder and arm pain. Heart attacks don’t always cause shoulder and arm pain. However, when the heart is injured, one of the places that pain can be experienced is in the shoulder and arm. How does this work?
In referred pain, the brain essentially gets confused by the messages it is receiving from the body and cannot determine where the pain impulses are coming from. Consider the hip. The nerve fibers that innervate the groin and hip ascend through similar pathways into the brain. When they arrive in the brain, the brain is not able to distinguish exactly which structure sends them and often decides they are originating from the groin.
Referred pain is common and occurs in a multitude of common scenarios:
- A degenerated intervertebral disc in the lower back can refer pain into the buttock and thigh. This referred pain is often confused with “sciatica.” Often, and in contrast to sciatica, referred pain is vague and diffuse.
- Arthritis in the small joints in the neck can refer pain into the arm. Sometimes patients come to the office and say they have upper arm pain and we discover the pain generator is actually a small facet joint in the neck.
- Even the gall bladder has a referral pain pattern. The gall bladder (rarely) can refer pain into the shoulder.
Fortunately, most referred pain patterns are characteristic and predictable (such as in the hip). Referred pain patterns are one more reason why it is important for you to not try and “self-diagnose” arthritis pain. Groin pain may be caused by a multitude of problems including a hernia, groin pull, hip labral tear, hip osteoarthritis, or other pathologic process. Instead of trying to sort it out yourself, see a doctor and let him or her evaluate you to make sure an accurate diagnosis is reached. An accurate diagnosis is the first step toward getting you better and back to your active, pain-free life.
Grant Cooper is a board certified, fellowship-trained physician who specializes in the non-operative treatment of spine, joint and muscle pain. He wrote for HealthCentral as a health professional for Osteoarthritis.