first look for a direct cause for the pain. When one
does not exist, diagnostic efforts extend to referred
causes. Injured nerves are common sources of
referred pain. Doctors do not fully understand the
physiologic mechanisms of referred pain.
COMMON SOURCES OF REFERRED PAINPain Felt May Arise From
beneath the right shoulder the gallbladder
in the shoulder or neck the diaphragm or esophagus
between the shoulder blades the stomach
in the groin the kidneys
in the middle of the back the kidneys or intestines
in the ear the throat
in the lower back the uterus or intestines
around the belly button the appendix
beneath the sternum the stomach or heart
in the sides (flanks) the kidneys
under the left arm the heart
back of the leg the lower spine
When to Seek Medical Care for Pain
Many people wait until pain becomes unbearable
before seeking medical evaluation and treatment,
particularly when no other symptoms exist. Such
reluctance may arise from a perception that one
should be able “tough it out” or from fear that the
pain indicates a serious health problem. Often
pain is an early symptom, however, and prompt
medical treatment can head off serious health
consequences. A person should seek medical eval-
uation for pain that
- arises suddenly for no obvious reason
- occurs with an injury and does not improve in
48 hours - worsens over time or recurs frequently
- is accompanied by symptoms such as blurred or
double vision, numbness or loss of function in
any part of the body, or difficulty breathing - occurs in the chest, particularly as a pressing or
heavy sensation - is associated with bloody sputum, vomit, urine,
or stools - interferes with regular activities
Chest pain may indicate HEART ATTACK and
requires urgent medical evaluation. All too many
people wait to see whether the pain will go away
instead of going to a hospital emergency room for
evaluation. The time wasted on such waiting can
be the difference between life and death or signifi-
cant disability due to permanent heart damage.
Though no one wants to feel silly for thinking he
or she is having a heart attack and then discover-
ing the problem is dyspepsia (heartburn) or acid
reflux, doctors would much rather this were the
case than for the person to delay seeking medical
care and have the symptoms turn out to be a
heart attack. Prompt medical intervention can
often minimize or prevent damage to the heart.Explaining Pain to the Doctor
Because pain is so subjective, it is often difficult to
quantify its intensity when explaining it to the
doctor. It can be helpful to present the doctor with
the answers to questions such as these:- Where does it hurt?
- How does the pain feel—is it sharp, dull, throb-
bing, steady, aching, sharp? It may be a combi-
nation of these sensations, or change in specific
circumstances. - How long has the pain been present? Has the
pain changed in any way since it started? - Under what circumstances is the pain present?
Is it constant or intermittent? Does it get worse
at night or with activity? - What makes the pain worse?
- What makes the pain better?
- Does the pain limit participation in usual activi-
ties? If so, from what activities and in what
ways?
Providing specific measures such as these help
both the person who has pain and the doctor
treating the pain to understand the effects the
pain is having on the person’s ability to function
in daily life.Appropriate Pain Relief
Analgesic medications (pain relief medications)
are the most common therapeutic approach for
acute and chronic pain. There are many kinds of
medications that provide pain relief; the appropri-
ate medications depend on the cause and natureunderstanding pain 387