Radiating Pain: Causes of Pain That Spreads or Shoots

Radiating pain vs referred pain

Referred pain happens because nerves from internal organs and from skin enter the spinal cord at the same levels, so the brain misreads the source. The diaphragm, for example, shares nerve roots with the shoulder, which is why irritation under the diaphragm causes shoulder-tip pain.

Common radiating pain patterns

Why do I get shooting pain in my sides?

Sudden shooting or stabbing pains in the side of the chest or belly have several common causes:

• Intercostal nerve irritation: the nerves running under each rib can be irritated by a twisted rib joint, muscle spasm, injury or after surgery. Pain is sharp, follows the line of a rib and may worsen with breathing or twisting. See intercostal neuralgia.
• Pinched nerve in the mid-back: a disc or arthritis in the thoracic spine can send shooting pain around the side in a band.
• Shingles: burning, tingling or shooting pain on one side of the body, followed 1 to 5 days later by a blistering rash in a strip. Pain can persist after the rash (postherpetic neuralgia).
• Kidney stones: severe waves of pain in the flank that shoot toward the groin, often with nausea and blood in the urine.
• Muscle cramps and spasms of the oblique or rib muscles.
• Gas and bowel spasm: brief sharp pains that move around and ease after passing gas.
• Pleurisy: sharp side pain on breathing in.

If the shooting side pain is severe, comes with fever, urinary symptoms or a rash, or keeps returning, see a doctor. For other causes of side pain by location, see side pain.

Nerve causes of radiating pain

• Herniated disc: the soft center of a spinal disc presses on a nerve root, causing pain along that nerve's path, often with numbness and tingling
• Spinal stenosis: narrowing of the spinal canal causes leg pain when walking that eases on sitting or bending forward
• Peripheral nerve compression: carpal tunnel syndrome, cubital tunnel syndrome and meralgia paresthetica
• Peripheral neuropathy: burning and shooting pains in both feet, often from diabetes
• Trigeminal neuralgia: electric-shock pain in the face

Organ causes of radiating pain

• Heart: angina and heart attack. Women, older adults and people with diabetes may feel mainly jaw, back or arm pain, breathlessness or tiredness
• Aorta: dissection causes sudden tearing pain that can move from the chest to the back
• Gallbladder: pain under the right ribs after fatty meals, spreading to the right shoulder blade
• Pancreas: severe upper belly pain boring through to the back
• Kidneys and ureters: flank pain shooting to the groin

How doctors find the cause

The doctor will map exactly where the pain starts and travels, and ask about its character, triggers, timing and associated symptoms such as numbness, weakness, breathlessness, nausea, urinary changes or a rash. They will examine the spine, nerves (strength, reflexes and sensation) and the relevant organs.

Tests depend on the suspected source:

• ECG and troponin for heart pain
• MRI of the spine for nerve root compression
• Nerve conduction studies for peripheral nerve problems
• Ultrasound for the gallbladder and kidneys, or CT for kidney stones and the aorta
• Urine and blood tests

Treatment

Treatment targets the cause:

• Nerve root pain: most sciatica and arm radiculopathy improves within 6 to 12 weeks with staying active, physical therapy and pain relief. Steroid injections or surgery are options for persistent or severe cases
• Nerve pain medicines such as gabapentin, pregabalin, duloxetine or amitriptyline for neuropathic pain, on prescription
• Shingles: antiviral medicine within 72 hours of the rash. The shingles vaccine is recommended for adults 50 and older
• Kidney stones: pain relief, fluids and sometimes procedures to remove the stone
• Heart and aortic causes: emergency treatment

For mild nerve-related pain, acetaminophen (paracetamol) or ibuprofen at the label dose, heat, gentle movement and avoiding prolonged sitting can help.

Frequently asked questions

What is radiating pain?

Radiating pain spreads or shoots from where it starts to another area, usually along a nerve. Sciatica, which travels from the lower back down the leg, is the classic example. Pain from an organ felt elsewhere, such as heart pain in the arm, is called referred pain.

Why do I get shooting pains in my sides?

Common causes are irritation of the nerves between the ribs, a pinched nerve in the mid-back, shingles, kidney stones, muscle spasm and trapped gas. Pain with a rash, fever, urinary symptoms or difficulty breathing should be checked by a doctor.

Can shoulder swelling cause pain that radiates to the head and eye?

Problems in the neck and upper shoulder muscles can refer pain up into the back of the head, temple and around the eye, a pattern called cervicogenic headache. A swollen, painful shoulder with headache, fever or visual changes needs prompt medical assessment.

Is pain radiating down the left arm always a heart attack?

No. It is often a pinched nerve in the neck or a shoulder problem. But because a heart attack can cause it, left arm pain with chest discomfort, breathlessness, sweating, nausea or lightheadedness is an emergency. Call 911 or your local emergency number.

How long does radiating nerve pain last?

Most pain from a pinched nerve root, such as sciatica, improves significantly within 6 to 12 weeks. Pain lasting longer, or with increasing weakness or numbness, should be reassessed, often with an MRI scan.