Pain

Pain can be due to a wide variety of diseases, disorders and conditions that range from a mild injury to a debilitating disease. The types of pain can be categorized as acute, chronic, referred, cancer, neuropathic, and visceral.

• Acute pain is experienced rapidly in response to disease or injury. Acute pain serves to alert the body that something is wrong and that action should be taken, such as pulling your arm away from a flame. Acute pain often resolves within a short time once the underlying condition is treated.

• Chronic pain is defined as lasting more than three months. Chronic pain often begins as acute pain that lingers beyond the natural course of healing or after steps have been taken to address the cause of pain.

• Referred pain is pain that originates in one part of the body but is felt in another part of the body.

• Cancer pain is due to nerve irritation caused by malignancy.

• Neuropathic pain is caused by damage to the nervous system and is often perceived as tingling, burning, and pins-and-needles sensations called paresthesias.

• Visceral pain is caused by a problem with the internal organs, such as the liver, gallbladder, kidney, heart or lungs.

Pain may occur with other symptoms depending on the underlying disease, disorder or condition. For instance, if your pain is due to arthritis, you may experience pain in more than one joint. Pain due to a compressed nerve in the lower back can even lead to loss of bladder control. Pain is often a major symptom of fibromyalgia, which is also characterized by fatigue and sleep problems.

The range of symptoms that may occur with pain include:

• Depression

• Flu-like symptoms (fever, chills, sore throat, fatigue, headache, cough

• Inability to concentrate

• Loss of appetite

• Muscle spasms

• Numbness

• Sleep disturbances

• Unexpected weight loss

In some cases, pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as a heart attack. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms, with or without pain, including:

• Bleeding symptoms, such as bloody urine or bloody stools

• Change in consciousness or alertness; confusion

• Chest pain radiating to the arm, shoulder, neck or jaw

• Difficulty breathing, wheezing, or shortness of breath

• High fever (higher than 101°F)

• Increased or decreased urine output

• Loss of bladder or bowel control

• Progressive weakness and numbness

• Redness, warmth or swelling

• Seizures

• Stiff neck and headache, with or without nausea or vomiting

• Weakness or lethargy

Hundreds of diseases, disorders and conditions can cause pain, such as inflammatory syndromes, malignancy, trauma, and infection. In some cases, pain may be a symptom of a serious or life-threatening condition, such as a heart attack or cancer.

Pain causes can include any kind of injury or trauma including:

• Amputation (removal of a body part)

• Avulsion (forcible tearing away of a body part)

• Blunt force trauma

• Broken bone

• Burn

• Electrical injury

• Eye injury, such as corneal abrasion

• Foreign body

• Laceration or contusion

• Sports or orthopedic injury, such as a torn meniscus or dislocated joint

• Sprains and strains

• Surgery

Pain can be due to degenerative and inflammatory disorders, such as:

• Appendicitis (inflammation or infection of the appendix)

• Degenerative disc disease

• Gout (acute inflammatory arthritis)

• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis

• Osteoarthritis

• Pancreatitis (inflammation or infection of the pancreas)

• Pelvic inflammatory disease

• Rheumatoid arthritis

• Vasculitis (blood vessel inflammation)

Pain can be caused by peripheral or central nervous system damage or injury from the following conditions:

• Complex regional pain syndrome (often triggered by trauma or nerve damage)

• Limb amputation (phantom limb pain)

• Multiple sclerosis (autoimmune disease)

• Neuroma (tumor of a nerve)

• Peripheral neuropathy (disorder of the peripheral nerves from your spinal cord)

• Pinched nerve (nerve impingement)

• Radiculopathy (damage to nerve roots from the spinal cord)

• Repetitive stress injury, such as occurs in carpal tunnel syndrome

• Shingles (viral infection that can cause nerve pain)

• Spinal cord injury

• Spondylolisthesis (when one vertebrae extends over another)

• Trigeminal neuralgia (facial pain due to the trigeminal nerve)

Pain can be caused by a variety of other diseases, disorders and conditions including:

• Cancer

• Cancer treatment

• Depression

• Fibromyalgia

• Heart attack

• Infection, such as a sexually transmitted disease (STD), meningitis, Salmonella food poisoning, or ear infection

• Ischemia (insufficient flow of blood to any tissue), such as results in gangrene

• Migraine, tension, or cluster headache

Pain is the most common reason for doctor visits. But it can be hard to decide when to see a doctor about pain. People have different pain tolerances. There are also different attitudes about pain that prompt some people to get help immediately and others to put off seeing a doctor. But pain is an indication of something happening in the body.

Sometimes, the cause of pain is not serious and will resolve on its own. Other times, it is best to see your doctor to find out what the problem is.

In general, if you have new pain that is not severe and does not go away, make an appointment to see your doctor. You should also make an appointment for pain that is causing worry or limiting your activities in some way.

See a doctor promptly when you have:

• Constant pain or pain that continues or intensifies when it should be better

• Pain along with unexplained weight loss or a fever

• Pain that interferes with your sleep or eating

• Pain you have never felt before

• Unexpected or unexplained pain

Call 911 or go to your nearest emergency room for pain when:

• You have chest pain.

• You have had pain, but it is changing, spreading or intensifying.

• You have pain with weakness, numbness or tingling.

• You have severe pain or pain you cannot tolerate.

• You have sustained an injury or trauma.

Your doctor will talk with you about your pain to understand where it hurts and how it feels. Then, your doctor may perform a physical exam to look for the cause of the pain. Sometimes, testing is necessary to aid in diagnosing the underlying cause of pain. Depending on the likely source of your pain, possible tests may include:

• Blood tests

• Electromyography, which tests a muscle’s activity

• Imaging exams, including X-rays, ultrasounds, CT (computed tomography) scans, and MRIs (magnetic resonance imaging)

• Nerve conduction study (NCS), which measures how well nerves carry impulses

• Spinal fluid tests

• Urinalysis

Questions for diagnosing the cause of pain

To diagnose the underlying cause of pain, your doctor or licensed healthcare practitioner will ask you several questions related to your symptoms. Questions for diagnosing the cause of pain include:

• Where is your pain?

• How would you describe your pain, such as sharp, burning, dull or achy?

• On a scale of 1 to 10 with 10 being the worst pain you can imagine, how would you rate your pain?

• When did the pain start?

• How long have you had pain?

• Is the pain constant or intermittent?

• What, if anything, makes the pain better or worse?

• Is the pain relieved with common over-the-counter medications, such as acetaminophen (Tylenol)?

• Do you have any other symptoms, such as weakness or fatigue?

Pain treatment depends on many factors, including the cause and whether the pain is acute or chronic. It also depends on your level of pain tolerance. Because there are many variables, pain treatment can be highly individualized. The goal in pain treatment is to reduce the pain and help you live with it until the cause resolves.

For acute pain, medications can often accomplish treatment goals. This may involve over-the-counter pain relievers, such as acetaminophen (Tylenol) and NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin). Or your doctor may recommend prescription pain relievers, such as narcotic analgesics. If an injury is the cause of pain, RICE (rest, ice, compression and elevation) may be part of the treatment plan.

For chronic pain, doctors may recommend several treatment strategies including:

• Behavior modification therapy

• Local electrical stimulation, such as TENS (transcutaneous electrical nerve stimulation), spinal cord stimulation, and brain stimulation

• Medications, including oral medicines, nerve blocks, and spinal medication pumps

• Physical, occupational and vocational therapies

• Surgery for a discernable physical cause

There are several kinds of home remedies to help relieve pain including:

• Applying heat or cold therapy

• Avoiding tobacco and alcohol

• Living a healthy lifestyle, including eating a balanced diet, getting plenty of rest, maintaining a healthy weight, and being as active as possible

• Practicing relaxation techniques, such as meditation, mindfulness, breathing exercises, and guided imagery

• Using correct body mechanics and posture

People who suffer with chronic pain, like any long-term medical condition, may benefit from a support group. It can help just to be around people who understand your journey. You may also learn different coping tips and strategies.

Some people find relief from pain with alternative medicine. These treatments may be especially helpful for chronic pain and include:

• Acupuncture and Reiki or touch therapy

• Aromatherapy using essential oils

• Biofeedback, which teaches you how to make a mind-body connection that can influence physical processes

• Hypnosis

• Massage therapy

• Music therapy and pet therapy

Complications associated with pain depend on the underlying disease, disorder or condition. For example, pain resulting from a degenerative condition such as multiple sclerosis can lead to inactivity and its associated complications. Fortunately, pain can often be alleviated or minimized by physical therapy, basic self-help measures, and following the treatment plan outlined by your doctor.

However, in some cases the degree and duration of your pain may become overwhelming and affect your everyday living. Research into the diagnosis and treatment of chronic pain is ongoing, so contact your healthcare professional for the latest information.

Over time, pain can lead to complications including:

• Absenteeism from work or school

• Dependence on prescription pain medication

• Pain that does not respond to treatment (intractable pain)

• Permanent nerve damage (due to a pinched nerve) including paralysis

• Physiological and psychological response to chronic pain

• Poor quality of life