Pain You Should Never Ignore

While many aches and pain are nothing to worry about, certain types of pain may be a sign of serious trouble

It's wise to pay attention to pain. That throbbing in your knee could be telling you to go easy on the yard work, and that ache in your head might be your body's plea for a nap or a tall glass of water. Some types of pain may even be a sign that you need to get to a hospital immediately.

"People have to make a judgment call for themselves, whether they're going to go to an emergency room or make an appointment with their doctor," says Robert Hockberger, MD, chair of emergency medicine at Harbor-UCLA Medical Center in Los Angeles. Paying close attention to pain can make that call easier to make. It could even save your life.

Of course, you shouldn't worry about every ache and twinge. Hockberger offers some general rules of thumb to separate run-of-the-mill pain from the kind that could signal a serious medical problem."We ask patients to rate their pain from a one to a 10," he says. "People who feel that their pain is a seven or higher -- anything worse than a bad toothache -- should see a doctor right away."

According to Hockberger, you should also see a doctor if you have moderate pain that doesn't go away within a few days, or if any treatment that previously relieved pain suddenly stops working.

You'll be way ahead in the guessing game if you familiarize yourself with some serious conditions that cause pain. This list is by no means definitive -- a roster of every painful malady could fill a medical book, and probably has -- but it's a good place to start. If you're alert to these problems, you're likely to get the help you need.

Leg pain with swelling

Symptoms: One of your legs suddenly becomes painful and swollen. The pain is especially noticeable when you stand or walk around. The swollen area -- most likely a calf or thigh -- may be red or warm.

What it could be: Deep vein thrombosis, a clot forming in a vein deep within the leg. Such clots are dangerous because they can break free and move to the lungs, causing a pulmonary embolism. (In 2003, a pulmonary embolism killed 39-year-old NBC reporter David Bloom.) Deep vein thrombosis most often occurs when a person isn't moving enough to keep blood flowing briskly through the legs. The condition is sometimes called "economy class syndrome," because it can strike during a long plane ride. People stuck in hospital beds are also at risk, as are people over 60, women taking birth control pills, women who have recently given birth, and anyone who is overweight.

What you should do: Make an appointment to see a doctor immediately. Be sure to tell your doctor if you've just finished a long trip or if there is any other reason to suspect a blood clot. Prompt treatment can clear the clot before it has a chance to cause trouble.

Sudden testicular pain

Symptoms: As unpleasant as it may be, imagine a swift kick to the groin. The pain, possibly along with swelling, will be on one side of the scrotum. This isn't just a dull ache. It's the type of pain that makes it difficult to walk or even talk.

What it could be: Testicular torsion. In this condition, the cord that connects to the testicles becomes twisted, cutting off blood flow. Other possible (but rare) reasons include testicular cancer and epididymitis, an infection of a small organ on the testicle. However, infections of the testicle tend to come on much more gradually and aren't nearly as painful.

What you should do: Get to a doctor immediately. If you do have testicular torsion, it's an emergency, because the testicle will become damaged without adequate blood flow.

Painful urination

Symptoms: You feel pain or a burning sensation when urinating. You may also have frequent urges to urinate without results.

Condition: You probably have an annoying but harmless urinary tract infection (UTI), but in very rare cases painful urination could also be a sign of something serious, like a sexually transmitted disease or, much more rarely, bladder cancer. (The classic sign of bladder cancer is the painless passing of blood in the urine.) Although UTIs are especially common in women, men are three to four times more likely than women to get bladder cancer.

What you should do: Schedule an appointment with your doctor or urologist. If it's nothing serious, treatment can quickly relieve the pain. If it is bladder cancer, prompt diagnosis can increase your chances of recovery.

Sudden chest pain

Symptoms: You suddenly feel unusual pain, discomfort, or pressure in the center of your chest. The feelings may linger for more than a few minutes, or they may disappear and come back. The pain and discomfort can spread to one or both arms or to the neck, jaw, stomach, or back. Other possible symptoms include shortness of breath, nausea, lightheadedness, or a cold sweat.

What it may be: You may have a pulmonary embolism (obstruction of a blood vessel by a clot or other matter), pneumothorax (too much air or gas in the chest cavity), or a bout of angina (chest pain caused by inadequate blood flow). You might also be having a heart attack.

Be aware that most heart attacks start much more slowly than the Hollywood variety -- you're more likely to feel a dull or vague pressure in the chest than a sharp pain. Some heart attacks are so subtle that it can be hard to tell then apart from simple indigestion or heartburn, Hockberger says. In many cases, it takes an EKG or other hospital test to tell the difference.

What you should do: If you think you might be having a heart attack or another medical emergency, don't wait any longer than five minutes to call 911 or get to a hospital. If you really are having a heart attack or embolism, waiting too long to get help could be a fatal mistake.

The worst headache of your life

Symptoms: Picture your worst headache -- even a skull-splitting migraine -- and imagine turning it up several notches. This mega-headache can strike suddenly, "like a thunderclap," Hockberger says. Other possible symptoms include double vision, nausea, vomiting, and a stiff neck.

What it may be: It could be just a bad migraine, but it could also be a ruptured aneurysm, bleeding in the brain that occurs when a weak spot in a blood vessel suddenly bursts. While migraines can cause similar symptoms, Hockberger notes that most people with migraines have their first episode before they turn 25. Doctors hear alarm bells when a person over 25 has the first killer headache of his or her life.

Every year, about 30,000 people in this country develop ruptured aneurysms. According to a report from Johns Hopkins Medical Institute, half of all ruptured aneurysms cause sudden death, but over 80 percent of patients who can make it to the hospital survive.

Anyone of any age can suffer a ruptured aneurysm, but they are more common in adults than in children. Smokers, people with hypertension, and people who abuse alcohol or illegal drugs are at especially high risk.

What you should do: Call 911 or get to an emergency room right away.

A stiff neck accompanied by fever and/or a severe headache

Symptoms: Many different things can cause sudden pain or stiffness in the neck. But if your neck trouble is accompanied by either a fever or a severe headache or both (often with sensitivity to light), you could be facing an emergency.

What it might be: You could be suffering from meningitis, an infection of the membrane that surrounds the brain. While meningitis can be caused by either viruses or bacteria, the bacterial kind is far more dangerous and potentially deadly. Bacterial meningitis comes on quickly -- you may feel perfectly fine one day and deathly ill the next. The condition can also cause vomiting, nausea, and a rash along with behavioral changes such as confusion and sleepiness.

What you should do: Call 911 or get to an emergency room right away.

Sudden, sharp pain in the abdomen

Symptoms: You have pain that starts at the center of the abdomen, usually in the area around the belly button. It eventually becomes more severe and shifts to the lower right side of the belly, making it painful to the touch. You may also have nausea, vomiting, a low-grade fever (under 100 degrees) diarrhea, constipation, inability to pass gas, swelling in the abdomen, and a lack of appetite. Eventually, it may become so painful that it hurts to move. You may even feel like someone has put a knife or a bullet in your guts -- from the inside.

What it may be: You may have appendicitis -- inflammation of the appendix -- a common emergency that's easy to dismiss as "just another stomachache." Ignoring the pain is dangerous, because an inflamed appendix could burst without prompt treatment.

The pain could also be a symptom of an inflamed gallbladder or pancreas. Just like an inflamed appendix, the gallbladder can rupture if it is not treated right away. An inflamed pancreas also needs prompt medical attention.

Finally, if you are female, you may have an inflamed ovarian cyst, a pelvic infection, or, if you're of childbearing age, an ectopic pregnancy.

What you should do: If you think you may have appendicitis, an inflamed gallbladder, or an ectopic pregnancy, get to a hospital quickly. An ectopic pregnancy can be life-threatening, and if your appendix really is inflamed, it needs to be removed before it causes serious problems. Every year, about 260,000 people in the United States have surgery to remove a troublesome appendix. If you suspect you have a pelvic infection such as pelvic inflammatory disease, seek medical attention quickly -- without treatment, this can cause permanent scarring, sterility, and in rare cases, a dangerous abscess.

Severe back pain

Symptoms: Back pain usually goes away on its own, with or without a doctor's help. But if the pain is sudden, agonizing, and unrelated to exercise or improper lifting, OR if you feel excruciating, highly focused pain on your spine, you may be in the midst of an emergency.

What it may be: Sudden, severe back pain may signal a kidney stone or an abdominal aneurysm, a bulge in the main artery leading from the heart. Kidney stones blocking the flow of urine tend to cause sharp or cramping pain that starts in the back or side and moves to the groin. Abdominal aneurysms, most common in older people with atherosclerosis, may produce only mild pain as the bulge grows. The pain suddenly becomes excruciating if the aneurysm bursts.

Intense, pinpoint pain may be a sign of an infection beneath the membrane that covers the spinal cord. This condition, called an epidural abscess, strikes about 10,000 people each year. If not treated promptly, it can cause paralysis of the lower part of the body, sometimes in just a few hours. Epidural abscesses often come on the heels of minor infections, such as infections of the sinuses or urinary tract. People with diabetes and IV drug users are most at risk.

What you should do: Call 911 or get to an emergency room right away.

Nagging foot or shin pain

Symptoms: Your normally full exercise schedule is slowed down by persistent pain on the top of your foot or the front of your lower leg. The pain builds gradually, gets worse when you put weight on your leg, and fades when you rest. If the pain is on the top of your foot, you might also notice swelling on the sore spot.

What it could be: A stress fracture -- a hairline crack in the bone. Stress fractures are common "overuse" injuries, often striking athletes in sports that give the feet a pounding, including track, basketball, and tennis. Adolescents and women with unusual or absent menstrual cycles are especially at risk.

What you should do: This isn't a medical emergency, but it's one time when you don't want to play through the pain. Schedule an appointment with your doctor or orthopedist to get a diagnosis. If you have a stress fracture, you'll need to take it easy for a couple of weeks to let your bone heal.

Pain is an imperfect guide to illness. Some conditions are painful but not dangerous, while other very serious conditions may strike with no pain at all. If you do have questions about a pain you have, it's best to consult your doctor.

References

Interview with Robert Hockberger, MD, chair of emergency medicine at Harbor-UCLA Medical Center in Los Angeles

American Heart Association. Heart attack symptoms and warning signs. http://www.americanheart.org/presenter.jhtml?identifier=4595

American Academy of Orthopaedic Surgeons. Stress fractures of the foot and ankle.

Cleveland Clinic. Appendicitis.

Johns Hopkins Medical Institute. Emergency or not? A tipsheet for the undecided. http://www.hopkinsmedicine.org/press/1999/JUNE99/990610.HTM

University of Massachusetts. Meningitis fact sheet. http://www.umassd.edu/studentaffairs/health/MeningitisFactSheet.html

National Institutes of Health. What is deep vein thrombosis? http://www.nhlbi.nih.gov/health/dci/Diseases/Dvt/DVT_WhatIs.html

US Food and Drug Administration. Avoid deep vein thrombosis: Keep the blood flowing. http://www.fda.gov/fdac/features/2004/604_vein.html

Galejs, L.E. and E.J. Kass. Diganosis and treatment of the acute scrotum. American Family Physician 59(4)

American Heart Association. Aortic aneurysm. http://www.americanheart.org/presenter.jhtml?identifier=4455

Stanford University. Information about bladder cancer. http://cancer.stanford.edu/urologic/bladder/

Centers for Disease Control and Prevention. Meningococcal Disease. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm

eMedicine. Aneurysm, Abdominal. http://www.emedicine.com/emerg/topic27.htm

Old, J.L. et al. Imaging for suspected appendicitis. American Family Physician. Vol. 71 (1) http://www.aafp.org/afp/20050101/71.html

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