# Referred Pain



## Guardian (Sep 2, 2006)

I like to read nursing textbooks for a variety of different reasons.  Sometimes the paramedic curriculum falls short and needs to be supplemented with nursing information, especially today when paramedics are seen more and more as general para-practitioners of medicine (unfortunately).  Other times, I marvel at the amount of trivial BS they teach nurses.  There are times however, when I run into valuable little tidbits of information.  While our treatment for "sick" people largely remains the same (O2, monitor, transport), I have found some useful information to aid in my assessments.  In my paramedic class, referred pain was mentioned briefly but never explained in applicable detail.  The following is some useful information about referred pain I learned recently.  If I am leaving anything out, please feel free to add more.

Pain associated with the heart usually shows up in the chest, lower side of the right arm and jaw (not always the case with women).  Pain concentrated in the xiphisternum is usually linked to stomach problems.  Pain in the LUQ near the costal arch is usually from the pancreas.  Liver pain manifest itself as right sided pain in the far lateral upper and lower right quadrants and pain in the upper right shoulder.  Pain in the symphysis pubis area is often linked to the bladder.  Pain in the umbilicus area is usually from the gallbladder.  Pain from the lungs and diaphragm usually shows up in the upper left shoulder and scapula area.  Right sided back pain is usually from the spleen.  Flank pain on one or both sides is from the kidneys.  Pain in the RLQ is from the appendix or ovaries if pain is bilateral.

Also, it is important to distinguish different types of pain.  Pain that last longer than 6 months (continuous or intermittent) is chronic pain.  Chronic pain usually does not evoke ANS response and is rarely responsive to analgesics.  In contrast, acute pain usually last less than 6 months.  It does evoke a CNS response (increased HR, RR, BP, diaphoresis, pupil dilation and muscle tension).  It is responsive to analgesics and diminishes after healing occurs.


----------



## klip (Jun 20, 2009)

*re: liver pain?*

Hi,

Where can referred liver pain be felt at?


----------



## ResTech (Jun 20, 2009)

In the right shoulder.... and referred pain from a splenic injury can be felt in the left shoulder.


----------



## 46Young (Jun 20, 2009)

Any online resources in regards? I'm also big on expanding one's knowledge base past the anemic medic curriculum.


----------



## daedalus (Jun 20, 2009)

Do not waste your time with Nursing texts. They teach nursing theory and nursing diagnosis. These books will provide you with the full story:

Guyton's Medical Physiology
Robbins Pathologic Basis of Disease
Harrison's Internal Medicine
Clinical Microbiology Made Simple
Limpincott's Illustrated Review: Pharmacology


----------

