Low back pain with referred pain can vary in severity and quality. It is felt as an achy dull discomfort which moves around and tends to come and go and often varies in intensity. This referred pain is usually felt in the low back area and tends to radiate into the groin, buttock and upper thigh. This type of low back pain is not as common as 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.
The brain cannot determine the specific source of the pain. Therefore, a careful history and physical examination by an experienced specialist is required to distinguish this type of pain from radicular/sciatica pain. The distinction between referred pain and radicular pain is critical because the treatment of the two types of pain varies considerably
Radicular (sciatic) pain radiates down the back of the leg to the calf and foot and is often secondary to compression (pinching) or inflammation of a spinal nerve. This type of pain is often felt as deep and steady and can usually be reproduced with certain activities and positions, such as sitting or walking. Radicular pain may also be accompanied by numbness and tingling, muscle weakness and loss of reflexes at the knee or ankle. When actual nerve malfunction is noted, this is referred to as “radiculopathy”.
With this condition, the leg pain is typically much worse than the low back pain, and the specific areas of the leg and/or foot that are affected depends on which nerve in the low back is affected. Compression of higher lumbar nerve roots such as L2, L3 and L4 can cause radicular pain into the front of the thigh and the shin.
Dr David, at The Annexe, Oxford or Harley Street, London will help with the diagnosis, investigation and treatment of referred or radicular pain.