Ouch! When you should worry about pain

Both doctors and patients worry about pain, because it is often a symptom of something seriously wrong.  However, we all experience some pain almost on a daily basis.  Whether it’s a paper cut, aching joint, or tension headache, everyone has pain as a regular part of their existence. 

So, if pain is so prevalent, how do you know when to worry about it?  If you adhere to the “no pain, no gain” philosophy, then you might not seek treatment when you really need it.  On the other hand, if you run to the doctor with every little hurt you will waste your time and your doctor’s.  Which brings me back to my original question: How do you know when to worry about pain?

What I tell my patients is to worry about pain like a doctor does. Of course, I don’t expect my patients to have the training and experience that gives doctors a good sense of what to worry about and what not to. But doctors also have some general guidelines we follow that help tremendously when it comes to diagnosing and treating pain.  They’re pretty simple, but I want to emphasize that these are general guidelines that work for most people and conditions.  My intention is not to encourage you to self-diagnose, but rather to consider the way that doctors evaluate pain symptoms.

Here are some hard and fast rules:

1. Any new and sudden onset of severe pain anywhere in the body is a concern and needs immediate medical attention. 
2. Any pain that occurs after significant trauma (e.g., fall from a ladder, car accident, sports injury, etc.) needs to be evaluated by a doctor.
3. Night pain is a concern because some serious conditions cause pain at night, such as cancer.  Night pain should be evaluated by a doctor, though it is often a musculoskeletal problem such as a rotator cuff injury in the shoulder.  Still, have a doctor check it out.
4. New pain in a person with a history of cancer deserves to be evaluated.  Of course, this doesn’t necessarily mean that the person is having a recurrence, but it’s important to have a doctor determine what is going on in this case.

The things I listed above are always things that doctors worry about and want to investigate further.  However, there are other things we consider, too.  Here are some further guidelines:

1. The “worst headache of my life” complaint from a patient may mean a ruptured blood vessel (aneurysm), and this is a medical emergency.  We always worry when someone complains of a severe headache, especially when it is unusual for them.  Of course, some migraine sufferers have severe headaches on a regular basis.  Even in those with migraine, if they get a headache that is not typical for them and is severe, it’s important to contact a doctor immediately. 
2. Chest pain or heartburn may be related to the gastrointestinal (GI) system (less worrisome) or the cardiovascular system (more worrisome).  Since symptoms of heart disease and GI troubles often mimic each other and may not feel truly painful, it’s difficult even for doctors to figure out what is going on without doing some tests.
3. I use the “two week rule” with a lot of pain that doesn’t fit into the guidelines I listed already.  What I mean by this is that I often counsel people to wait two weeks to see if their pain goes away.  This is fine to do in most circumstances (though I’ve listed exceptions above and should include here that any pain that someone is really worried about should be checked before two weeks).  The two week rule works well, for example, in a situation where a person injures her back mowing the lawn.  Most back pain will resolve within two weeks, so it’s fine to wait and see what happens. 
4. Use common sense, and if you are worried, get help.  My kids have quite a lot of pain complaints, so I’ve gently explained the two week rule to them.  One day a neighbor boy fell off of his skateboard and his mom brought him over to see me.  He didn’t need stitches but as my daughter was handing me bandages to dress his wounds she asked why I didn’t tell him about the two week rule.  I told her that when there’s blood present, the two week rule doesn’t apply.  However, this brings out an important point—no guidelines work in every situation and common sense helps a lot when you are trying to figure out what to do next.

I hope that these guidelines help you to worry about pain like a doctor would, but that they don’t keep you from seeking treatment from a medical expert.  These are general guidelines that doctors use, but there is a lot of information that is not listed in this blog that your doctor will use to give you a personal diagnosis if you come to him or her with a pain problem. 

How do you decide when to seek treatment for pain?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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