The different kinds of pain
One thing that can really interfere with your wellbeing is pain. When the warning light comes on that part of your body is not what it should be, it’s time to take notice. Electrical signals buzz through myriad fibres and connections to send signals to the cortex of your brain that says, ‘‘Houston, we have a problem!’’ What you need to work out is how big that problem is, and what you should do about it.
One of our biggest jobs in the Emergency Department is trying to diagnose and treat pain. It’s a complex business with multitudes of causes, effects and outcomes. We can see a spectrum of disorders and presentations, from the worried well, the stoic and the serious. We have fancy tests and scans that can help us decipher if your pain is in fact the harbinger of something nasty, or something than can be relieved until the symptoms pass.
Pain can be acute or chronic in origin. There are books written on chronic pain and how the nervous system becomes oversensitised and there are chronic pain teams that try to decipher and unravel the causes and treatments to alleviate suffering. From patches to potions it can be sometimes very difficult to manage.
Acute pain is often a new presentation and your brain doesn’t know where it’s coming from, what the cause is or how to treat it. It may come on suddenly or gradually build and recede then build again, which we describe as colicky. Gallstones and kidney stone pain often comes in waves as your body is trying to expel a bit of gravel from your plumbing.
Sudden onset pain may be due to a blood vessel or cyst bursting, in your pelvis, your knee or almost anywhere else you have plumbing. We are still surprised sometimes when patients present with minor aches and pains and we ask if they have taken anything for it, and the answer is no.
Simple analgesia such as paracetamol or ibuprofen may be all you need to get you through the hump until your body heals itself. The flip side is if you are taking large amounts of over-thecounter pain killers, you could be damaging your liver and kidneys.
If it’s a sports injury, simple analgesia, rest, ice and compression may do the trick. If you can’t control the pain with simple, over-the-counter painkillers then an X-ray to exclude a fracture may be a good idea. If your pain is so debilitating, call an ambulance.
Useful information for us is how long you have had the pain, did it come on suddenly, what were you doing at the time and does anything make it better or worse.
Pain in your abdomen when coughing, sneezing or moving is not normally a good sign and may mean you have something serious like appendicitis.
Headache pain with visual disturbances, not liking bright lights could be a migraine. If you have a fever as well it could be meningitis. That’s why we have blood tests and scans to try to find 123RF the cause and treat it.
Pain that is getting worse is a sign you need to get help. Whether it’s your pharmacy, GP or hospital, trying to find the cause and treat it early is the key to good management and regaining your wellbeing. ● Dr Tom Mulholland is an Emergency Department Doctor and GP with over 25 years’ experience in New Zealand. He’s currently a man on a mission, tackling health missions around the world.