Acute Pain: When to Get Help
The biggest mistake that people make is to treat pain on their own without knowing the cause. This can be dangerous or even life-threatening. If, for example, you have a pain in your belly, and you take an over-the-counter pain medicine, you might be covering up the symptoms of appendicitis, which often requires immediate surgery. So the first step when you are in pain is to determine what is causing it. The next step is to decide what to do about it. This book will give you the information and the tools to do both. You will learn when to call the doctor, when to take medicine, when to go to the emergency room, and—if it is appropriate—when to use lifestyle modifications and alternative treatments that are the most effective for your pain.
There are two kinds of pain: acute and chronic. Acute pain usually comes on suddenly and has an obvious cause: a broken bone, an internal infection, a pulled muscle, a burn. This kind of pain usually requires conventional medical treatment such as surgery or drugs. Sometimes, acute pain requires emergency treatment, and for this you need to contact your doctor, go to the emergency room of a hospital or call for an ambulance. This first chapter lists the kinds of acute pain for which you should seek medical help, either at your doctor's office or in an emergency room.
Chronic pain, by contrast, is something that may have an obvious cause, like arthritis, or it may persist even after an injury has healed. But for many people with chronic pain, the cause is not immediately clear. This kind of pain is a frequent and unwelcome companion: aches and pains in the back, neck, shoulders or joints come and go with irritating regularity, often interfering with activities and the enjoyment of life.
Chronic pain is the major focus of this book. Most pain, particularly as we get older, is not a sign of something serious like cancer, but is a manifestation of general wear and tear on the joints, muscles and tissue that makes up our bodies. You do not have to suffer with chronic pain; there are ways to become more comfortable.
Acute Pain: When to Seek Help
It is important not to ignore certain kinds of pain. Sometimes pain can be an early warning sign of a potentially serious illness or a tumor. The rest of this chapter gives you guidelines for the kind of pain for which you should seek immediate medical help.
Acute pain (coming from an actual or potential injury) keeps us safe: jerking our hand away from a hot stove or boiling water will prevent a burn, for example. People without adequate pain sensations can seriously injure themselves without realizing it. Following is a summary of pain that needs immediate medical attention. But if something isn't mentioned here, and if you're not sure, always call your doctor.
If you or your family members experience any of the pain symptoms described in this chapter, do not ignore them, hoping that they will go away. Take action, either by calling your doctor or going to the emergency room of a hospital. As a general rule: Do not ignore pain that is so severe that it keeps you up at night or pain that is new and unexplained.
Head and Neck
Headache
We will discuss chronic headaches, such as migraines, later in this book. However, if you experience an acute, sharp headache that lasts more than an hour and is associated with blurry vision, difficulty talking, or weakness in the arms or legs, get immediate medical help. These symptoms may indicate a stroke or a brain aneurysm. In either case, minutes may make the difference between life and death, permanent disability and recovery.
Severe, intense headache with fever, cold symptoms, neck stiffness and drowsiness in children or adults may be a symptom of meningococcal meningitis—a life-threatening condition. Sometimes these symptoms are associated with a pinpoint red rash on the neck or upper chest. Call your doctor or 911, or go to the emergency room immediately.
Chest and Upper Back
Chest Pain
Pain in your chest that feels progressive in its severity—like heartburn or a weight on your chest—or that radiates into your left jaw, neck or arm, should be considered the symptoms of a heart attack until proven otherwise. If you experience these symptoms, chew a couple of aspirin tablets, stay calm and have someone drive you to an emergency room or call 911. If you feel lightheaded, dizzy or short of breath, call 911 immediately and notify your doctor.
Acute Pain Radiating from the Neck or Back
Acute, severe pain in the arms and/or legs that radiates from the neck or back and which may be associated with numbness, tingling, stabbing, burning or weakness may be a symptom of a herniated disk in the spine. What may be confusing about these symptoms is that they may not radiate from the spine. They are sometimes localized around the elbow, knee or ankle and may be confused with symptoms coming from these joints.
Between the vertebrae of your spine are disks. These disks are made up of a tough outer rim, like a tire, and a gummy center, and they act as cushions between the bony vertebrae of your spine. If the rim develops a defect and the center bulges out, the disk is said to be herniated. If this bulge compresses a nerve leading to the arm or leg, it causes radiating symptoms of pain. The most common place for a herniated disk is in the low back, where it can press on the nerves leading to the sciatic nerve, causing sciatica—with pain radiating down the back of the buttocks, the front or back of the thigh, or lower leg and into the foot. A herniated disk can happen suddenly as the result of a movement, or the pain can develop more insidiously and gradually.
If the pain is severe and is associated with weakness or loss of sensation, stumbling or tripping, contact your physician or have someone take you to the emergency room.
Severe Back Pain Associated with Belly Tenderness
Acute, severe, unrelenting pain down the middle of your back or in the low back that is associated with belly pain may be a symptom of an aortic aneurysm. This is a bulge in the main artery leading away from the heart. Sometimes this bulge causes a slight tear in the aortic wall. This is an emergency. If the artery ruptures, it can result in death. You are more at risk for an aortic aneurysm if you are male and middle-aged or older. You are also at risk if you are or have been a smoker, either male or female.
Belly and Low Back
Belly Pain
Pain in your belly, particularly when it is associated with nausea and/or vomiting and tenderness to touch, should be considered a symptom of a condition called 'acute abdomen.' If this condition is associated with tenderness:
• On the lower right side, it could be appendicitis.
• On the upper right side, it could be gall bladder disease.
• On the upper left side, it could be stomach ulcer.
• On the lower left side, it could be diverticulitis (a pouch on the outside of the wall of the intestine that could rupture and lead to infection; classic symptoms include fever, decreased appetite and diarrhea).
All of these conditions should receive immediate medical attention.
Pain Between the Chest and Low Back
Acute, severe back pain at the junction between the chest and the low back can be a symptom of a kidney stone. This kind of pain usually starts on one side and radiates down into the flank and groin area. Pain from a kidney stone comes in spasms and is usually associated with nausea and sometimes with vomiting, sweating and lightheadedness. You may or may not have pain when urinating or have blood in the urine.
If you have this kind of pain, it soon becomes apparent that you need to go the emergency room. The pain is agonizing. It will not let up and there is nothing you can do to relieve it on your own. You should not try to 'wait it out,' since the kidney stone may not pass out of your body without medical intervention. Your doctor can give you medication to help get rid of the stone more quickly.
These symptoms may also indicate a herniated disk or sciatica. (See 'Acute Pain Radiating from the Neck or Back.')
Shoulder, Arm and Hand
Shoulder Pain
Pain in the shoulder is very commonly associated with arthritis or bursitis. But if you are unable to raise your arm from your side, you may have a frozen shoulder. This condition typically occurs after trauma to the shoulder and may be dramatically relieved by acupuncture. More commonly, however, the condition is effectively treated by supervised physical therapy. Massage is not a good idea for a frozen shoulder as it causes irritation and may make it worse.
Pain and Numbness in the Hand
If you wake at night with pain in your hand associated with numbness, particularly in the thumb, index and middle fingers, stand up and shake your hand. If this relieves the pain and numbness, you could have carpal tunnel syndrome. Although this condition is usually attributed to overuse and repetitive activities such as typing, it is also associated with some form of arthritis or diabetes. See a hand specialist if these symptoms interfere with your daily activities or regularly disturb your sleep.
Hips, Legs and Feet
Aching in Legs
An aching sensation down the front and outside of the lower leg below the knee that becomes more intense with fast walking or running is a symptom of shin splints. If it lasts after exercising and is bad enough to make you lie down and you are still in pain, it could also be a stress fracture in a lower leg bone. Both shin splints and stress fractures are common in long-distance runners, new army recruits and people who are out of shape.
Stress fractures can be dangerous if left untreated: They can develop into full-blown fractures in the hip, lower leg or foot, requiring orthopedic surgery that can take months to heal. Do not ignore them. See your doctor.
Aching and pain in the leg that does not go away after you stop walking or running may also be a symptom of compartment syndrome, which causes swelling in the muscle on the outside of the lower leg. It may also be a sign of poor circulation in the legs, called intermittent claudication. Compartment syndrome is an emergency, comparable to appendicitis, because if it is not immediately treated it can kill the muscle and cause permanent weakness in the foot. Claudication can be treated by your physician.
Pain and Swelling in the Foot
Pain in the base of the big toe that is severe and is associated with swelling and redness may be the first signs of gout. This is a form of arthritis in which uric acid crystals form in the joint and cause irritation. It can attack any joint and is usually attributed to eating rich foods. (Henry VIII is thought to have suffered from gout in his later years.) Most people who have gout, however, have an inherited weakness for the disorder. Gout needs to be diagnosed by a physician. If left untreated it can affect the kidneys.
Whole Body
Generalized Aches and Pains with Weakness, Sweatiness and Cold Symptoms
These symptoms are most commonly part of a flu syndrome, but if they are not, they could indicate a serious disorder called polymyositis. This is a rheumatologic disorder that affects muscles and tendons and requires treatment with steroids. Patients with polymyositis often delay seeking help from their doctors for several months. As soon as you begin to notice weakness in everyday activities, such as getting up from a chair, going up stairs or stepping up onto a curb, you should call your doctor.
Severe Joint or Bone Pain that
Keeps You Up at Night
While arthritis pain is common, it is benign and can be treated. (See 'Osteoarthritis' section.) However, severe pain in the bones and joints that gets worse and keeps you up at night should not be ignored. If this pain does not respond to rest or over-the-counter pain medication, call your doctor. This could be the symptom of an infection, fracture or tumor.
Painful, Burning, Linear Rash
If you have rash that is in a straight line, has a painful, burning sensation and makes your skin supersensitive to touch, you may have shingles. This is a viral infection of the sensory nerves that is highly contagious by touch and is caused by the same virus that causes chicken pox. Shingles can occur on the face or anywhere on the body, but it usually begins in the area of the spine and follows the pattern of the sensory nerves around one side of the body. Do not touch or scratch it and then rub your eyes because this virus can infect the eye and cause blindness. See a doctor as soon as you notice this rash. There is medication that can shorten the course and alleviate symptoms. The virus that causes shingles may lie dormant in the body for years, so it is hard to tell when exposure occurred.
Pain in Children
The general rule is: Do not ignore pain in children. Children typically do not complain of pain unless they have it. Under the age of two, children express pain through irritability or screaming if you touch or move a part of their bodies that hurts. Following a cold, infants can develop an infection in the bloodstream that can seep into any joint—especially the hip—that could damage the joint. In this situation, the baby will be irritable or scream if you touch or move the infected arm or a leg. Take the baby immediately to the emergency room. If the baby is rigid and stiff, especially in the neck, suspect meningitis and go immediately to the emergency room.
Older children complaining of belly pain may have appendicitis, which requires emergency treatment. Limping or joint pain might indicate an injury or infection in the bone or joint, which should be checked by your pediatrician. Neck stiffness may be a symptom of meningitis.
(For more information about children's illness, see Own Your Health: Your Sick Child, another book in the Own Your Health series.)
©2007. Adam Perlman, M.D. and Roanne Weisman. All rights reserved. Reprinted from Own Your Health : Pain - Back Pain, Arthritis, Migraines, and More. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the written permission of the publisher. Publisher: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach, FL 33442. |
