Back, chest and abdominal pain - is it spinal referred pain?

BACKGROUND In patients with pain in the back, chest or abdomen, it may be difficult to differentiate nonmusculoskeletal causes from musculoskeletal causes. OBJECTIVE This article discusses the mechanisms of musculoskeletal referred pain and the key clinical features that help the practitioner differentiate such pain from nonmusculoskeletal pain, thereby informing appropriate management. DISCUSSION Patterns of pain referred from musculoskeletal structures in the back have been well documented from experimentally induced pain. The key features on history that point to spinal referred pain are pain on movement, tenderness and tightness of musculoskeletal structures at a spinal level supplying the painful area, and an absence or paucity of symptoms suggestive of a nonmusculoskeletal cause. Radiological investigations are often of little value in confirming a musculoskeletal cause. A positive response to therapy directed at the musculoskeletal source supports - but does not prove - a diagnosis of musculoskeletal referred pain.