Why pain is not always where it hurts
A toothache can come from the masseter. Tingling in the hand can originate in the neck. Sciatica can be merely tension in the piriformis — with a completely normal MRI. The human body is a network of referred-pain patterns, and much of the diagnosis of chronic pain is recognizing the pattern before treating it.
This guide organizes the 30 most-searched chronic pain symptoms into six anatomical regions. For each symptom, we present the most likely muscle or structure, the criteria to differentiate it from serious causes (warning signs), and the evidence-based medical approach — including medical acupuncture, dry needling, and complementary therapies when indicated.
Where is your pain?
Choose the region closest to where you feel discomfort. Each card leads to a specific analysis of the symptom, common referred-pain patterns, and the indicated medical treatment.
Head and face
6 symptomsHeadaches, muscular dental pain, TMD, and eye pain referred from the neck. The "great imitators" of this region typically originate in trigger points distant from where the pain is felt.
Neck and shoulder
5 symptomsThe region most densely connected to "systemic" symptoms — dizziness, tinnitus, heaviness in the neck. Identifying the trigger muscle changes the prognosis.
Arm and hand
4 symptomsParesthesias, tingling, and tennis elbow. Nerve compression is not always at the wrist — it frequently begins higher up, in the neck or scalenes.
Trunk and back
5 symptomsPostural low back pain, musculoskeletal chest pain, and sciatica. Trigger points in the psoas and quadratus lumborum imitate disc-herniation patterns.
Hip and pelvis
6 symptomsFalse trochanteric bursitis, false sciatica, chronic pelvic pain, and coccydynia. Tension in the piriformis and pelvic floor is frequently underdiagnosed.
Leg and foot
4 symptomsPatellofemoral pain, plantar fasciitis, and nocturnal cramps. The neurofunctional approach treats the muscle generating the pain, not just where the pain is felt.
Head, face, and jaw
Headaches, muscular dental pain, TMD, and eye pain referred from the neck. The "great imitators" of this region typically originate in trigger points distant from where the pain is felt.
Band-like pressure tightening around the head
Suboccipitals and trapezius — tension headache
Pain behind the eye and at the back of the neck
Cervical trigger points and cervicogenic headache
Toothache without a dental cause
Masseter and temporalis referring dental pain
Headache and jaw pain on waking
Sleep bruxism and morning headache
Jaw clicking, popping, and locking
TMD — pterygoids and masseter
Pain behind the eye from cervical trigger points
Eye pain referred from the neck
Neck, shoulder, and shoulder girdle
The region most densely connected to "systemic" symptoms — dizziness, tinnitus, heaviness in the neck. Identifying the trigger muscle changes the prognosis.
Heavy shoulders and stiff neck
Chronic myofascial tension in the shoulder girdle
Neck pain that locks (constant torticollis)
Levator scapulae — cervical release
Sensation of a "knot" or "ball" in the shoulder/neck
The myofascial taut band and dry needling
Dizziness, tinnitus, and vertigo associated with neck pain
Sternocleidomastoid and cervicogenic symptoms
Sharp shoulder pain when raising the arm
Supraspinatus and infraspinatus — shoulder impingement
Arm, forearm, and hand
Paresthesias, tingling, and tennis elbow. Nerve compression is not always at the wrist — it frequently begins higher up, in the neck or scalenes.
Numbness and tingling in the fingers
Carpal tunnel and differential diagnosis
Numbness in the arm and hand while sleeping
Scalene compression — a carpal-tunnel imitator
Finger tingling that worsens in the cold
Cervicobrachial tension and scalenes
Elbow pain that radiates to the forearm
Lateral epicondylitis — supinator and extensors
Trunk, back, and lower back
Postural low back pain, musculoskeletal chest pain, and sciatica. Trigger points in the psoas and quadratus lumborum imitate disc-herniation patterns.
Low back pain that worsens when sitting
Iliopsoas and quadratus lumborum — postural low back pain
Deep low back pain when getting up from a chair
Quadratus lumborum and psoas — mechanical low back pain
Shock-like leg pain when walking
Sciatica — inflamed sciatic nerve
Back pain that worsens with deep breathing
Rhomboids and erector spinae — respiratory thoracic pain
Stabbing chest pain — false heart attack
Pectoralis minor and intercostals — musculoskeletal chest pain
Hip, pelvis, and abdomen
False trochanteric bursitis, false sciatica, chronic pelvic pain, and coccydynia. Tension in the piriformis and pelvic floor is frequently underdiagnosed.
False sciatica — leg pain with a normal MRI
Piriformis and gluteals — pseudosciatica
Lateral hip pain when lying down
Gluteus medius — false trochanteric bursitis
Groin pain when walking or climbing slopes
Iliopsoas — the hidden hip flexor
Tailbone pain when sitting
Pelvic neuromodulation — chronic coccydynia
Chronic pelvic pain with no cause on imaging
Pelvic floor — myofascial pelvic pain
Chronic abdominal pain without a gastric cause
Abdominal wall and the Carnett sign
Knee, leg, and foot
Patellofemoral pain, plantar fasciitis, and nocturnal cramps. The neurofunctional approach treats the muscle generating the pain, not just where the pain is felt.
Pain around the kneecap when descending stairs
Vastus medialis and lateralis — patellofemoral pain
Sharp heel pain on the first step in the morning
Plantar fasciitis and morning plantar pain
Heel pain on waking (which is not a heel spur)
Soleus and calf — referred plantar pain
Nocturnal calf cramps
Dry needling — preventing nighttime episodes
Diffuse pain or pain without a fixed location
When pain shifts location, spreads, or persists without a clear lesion, the mechanism involved is central sensitization — an increase in nervous-system excitability that acupuncture neuromodulation can help regulate.
How medicine approaches chronic pain
Pain treatment is not a single protocol. A pain medicine specialist (or physician acupuncturist) assesses the dominant mechanism — nociceptive, neuropathic, nociplastic, or myofascial — and combines modalities from different axes: minimally invasive procedures, rehabilitation, specific exercises, and pharmacotherapy.
To understand how treatments are chosen and combined, see the pillar guide on Pain Medicine. To search all symptoms and filter by region, use the full symptom map.