Referred Pain: How Organs Can Cause Pain in Surprising Parts of the Body
- Davide Rossi
- Sep 16
- 4 min read
Introduction: Pain Isn’t Always What It Seems
Most of us assume pain means something is wrong exactly where it hurts. A stiff shoulder? Must be a muscle knot. Back pain? Probably posture or overexertion.
But the body doesn’t always work that way. Sometimes, the ache you feel in your shoulder, jaw, or back is not coming from the muscles or joints at all—it’s coming from your internal organs. This phenomenon is called referred pain, and it can be confusing, misleading, and even life-saving if recognized in time.
In this guide, we’ll explore what referred pain is, why it happens, and the most common organ-to-body pain connectionsyou should know about.
What Is Referred Pain?
Referred pain is when pain is perceived in a different location from where it originates.
This happens because nerves from different parts of the body share the same spinal cord pathways.
The brain sometimes “mislabels” the source of pain, making you feel it in a muscle or joint when the true problem lies in an organ.
👉 Example: Gallbladder inflammation can create pain in the right shoulder, even though the gallbladder sits under your ribs.
Think of it as your body’s electrical wiring getting a little “crossed.”
Major Organ–Pain Connections
Let’s walk through the most important referred pain patterns you should know.
1. Gallbladder & Liver → Right Shoulder / Neck
Nerves involved: Phrenic nerve (C3–C5), T7–T9
How it feels: Dull pain in the right shoulder, under the scapula, sometimes up the side of the neck.
Why it happens: Inflammation of the gallbladder or liver irritates the diaphragm, which shares nerves with the shoulder region.
When it appears: Often after fatty meals, with bloating or nausea.
Example: Gallstones, cholecystitis.
2. Heart → Left Arm, Jaw, Neck
Nerves involved: T1–T5
How it feels: Pressure, heaviness, or pain radiating to the left arm, jaw, or neck.
Why it happens: Cardiac nerves overlap with nerves supplying the arm and jaw.
When it appears: During exertion, stress, or at rest in severe cases.
Example: Angina, myocardial infarction (heart attack).
3. Diaphragm / Spleen → Left Shoulder (Kehr’s Sign)
Nerves involved: Phrenic nerve (C3–C5)
How it feels: Sharp pain at the tip of the left shoulder.
Why it happens: Irritation of the diaphragm transmits signals to the shoulder.
Example: Splenic rupture, peritonitis, abdominal bleeding.
4. Kidneys & Ureters → Flank, Lower Back, Groin
Nerves involved: T10–L1
How it feels: Severe flank or back pain, often radiating to the groin or inner thigh.
Why it happens: Shared nerve pathways between kidneys and lower trunk muscles.
Example: Kidney stones, kidney infection (pyelonephritis).
5. Stomach → Mid-Back
Nerves involved: T6–T9
How it feels: Burning or aching pain in the upper abdomen that radiates to the mid-back.
Why it happens: Gastric nerves overlap with thoracic spinal nerves.
Example: Gastric ulcer, gastritis.
6. Pancreas → Upper Abdomen & Back
Nerves involved: T6–T10
How it feels: Deep abdominal pain radiating straight through to the mid or upper back.
Example: Pancreatitis.
7. Appendix → Navel → Right Lower Abdomen
Nerves involved: T10 initially, then L1 as inflammation progresses.
How it feels: Starts near the belly button, then shifts to the lower right abdomen.
Sometimes: Radiates toward the thigh or testicle.
Example: Appendicitis.
8. Bladder → Suprapubic Area, Inner Thigh, Perineum
Nerves involved: S2–S4
How it feels: Pressure or discomfort in the lower pelvis, sometimes radiating to the thighs.
Example: Bladder infection (cystitis), urinary irritation.
9. Colon → Abdomen, Sacrum, Back
Nerves involved: T10–L2, S2–S4
How it feels: Cramping abdominal pain, sometimes radiating to the sacrum or lower back.
Example: IBS, inflammatory bowel disease, colitis.
10. Uterus & Ovaries → Lower Back & Thighs
Nerves involved: T10–L1, S2–S4
How it feels: Lower back pain radiating into the sacrum or thighs.
Example: Dysmenorrhea, ovarian cysts, endometriosis.
Why Does the Brain Get Confused?
The brain is great at locating pain from skin and muscles, but not from organs.
Since visceral nerves and somatic nerves converge on the same spinal cord segments, the brain often “assigns” the pain to a body region it knows better.
When to Suspect Referred Pain (vs. Muscle Pain)
You should consider an organ cause if:
Pain is deep, vague, and hard to localize.
It comes with systemic symptoms (fever, nausea, digestive upset).
It is not clearly triggered by movement or posture.
If pain changes with posture, stretching, or activity → it’s more likely musculoskeletal.
Diagnosis: How Doctors Tell the Difference
Physical exam (checking both muscles and abdomen).
Blood tests (liver enzymes, kidney function, cardiac enzymes).
Imaging (ultrasound, CT, MRI depending on suspected organ).
Referrals to specialists (cardiology, gastroenterology, urology, gynecology).
Solutions: What to Do
If organ-related:
Seek medical care promptly.
Follow prescribed treatments (from diet adjustments to surgery if needed).
Support overall health with hydration, balanced nutrition, and exercise.
If musculoskeletal:
Improve posture and ergonomics.
Perform stretching and strengthening exercises.
Manage stress with breathing techniques and relaxation.
Conclusion: Listen to the Signals
Not all pain is what it seems. Sometimes your shoulder, back, or jaw pain is actually your organs asking for attention.
Most pain is benign and musculoskeletal, but knowing the classic patterns of referred pain could help you recognize when something deeper is going on—and when to seek medical help.
✅ Key Message: Pain in your body doesn’t always come from where you feel it. Understanding referred pain can give you insight, clarity, and sometimes even save your life.
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