How to detect what's causing your pain?

Pain hurts for a reason - it's a warning to our body that something is wrong - if we step into a boiling hot bath, we jump out sharpish. But how do you know when to ignore it or take a painkiller, and when it could be serious?

Causes of pain

Superficial pain on the outside of the body happens largely because of pain receptors in our skin. They send messages via dedicated nerve fibres up the spine to the brain, where pain is registered. Many but not all other organs have pain receptors too. For instance, your brain doesn't actually feel pain as it has no pain receptors. Headaches happen because other nearby parts of the body, which are well supplied with so-called 'nociceptors', send messages to the brain.

Sometimes the brain gets confused about where the pain is coming from. This can result in 'referred pain' which comes from one part of your body but is perceived in another. For instance, if you have a heart attack you can get pain up your neck or down one arm; a sore throat can cause earache; pain under your diaphragm can make your shoulder hurt. Doctors are often taught to 'beware the limping child with a painful knee' because hip pain in children can be 'referred' to the knee.

There has been lots of interest over the years in the 'gate theory of pain'. The theory is that there are lots of junctions in the nerves carrying messages about pain from any part of your body to the brain. If these junctions, or gates, are getting lots of stimulation from non-pain sensors (eg, through rubbing a bit of your body you've just banged) then they will be 'closed' to pain messages.

TENS machines are widely used in labour but also in chronic pain. The theory is that the tiny electrical impulses they send out help keep the pain gates closed, relieving pain. Stress, anxiety, boredom and being physically inactive all contribute to 'open pain gates' - which is partly why relaxation really can relieve pain. It's also partly why talking therapies can be hugely effective if you have chronic or severe pain.

Seeing a doctor about your pain

Because there are so many kinds of pain, it's hard to say exactly when you should see a doctor. But as a rule of thumb, if a pain is accompanied by other symptoms (eg chest pain with breathlessness; tummy pain with persistent vomiting; almost any pain with abnormal bleeding; back or neck pain with weakness or numbness in your arms or legs) you should see a doctor. If in doubt, speak to your pharmacist or ring your GP first. Your pharmacist can advise on lots of painkillers which are just as effective as the ones you can get on prescription.

Almost all of us suffer pain at some time. Often it's due to minor bangs or strains, and will settle down on its own within days. Taking painkillers - either tablets or, for muscle or joint aches, topical painkilling gels - usually won't do any harm in the short term and can let you get on with life. However, it is important to realise that taken in high doses or long-term, painkillers including non- steroidal anti-inflammatory drugs, like ibuprofen or naproxen can cause significant side effects for your stomach lining, kidneys and possibly your heart. Likewise, taking painkillers too often for headaches can actually make the headaches worse, leading to so-called medication-induced headache.

Lots of people are very worried about doing anything that brings on pain because they think it must mean more damage is being done. It doesn't necessarily, and sometimes you'll do far more harm than good by avoiding pain completely.

Take osteoarthritis - the most common cause of joint pain across the world, it affects at least half of over 65-year-olds and often starts younger. It mostly affects knees, hips, fingers and lower spine. Pain and stiffness are the main symptoms of arthritis - the stiffness if often worse in the mornings and the pain tends to get worse with exercise. But perversely, keeping active is probably the single most effective way of cutting the risk of arthritis getting worse and avoiding pain in the longer term.

One of my practice partners, who's an expert in joint problems, talks about 'knocking on the door of pain' - in other words, avoiding any strenuous exercise that makes the pain very severe, but making every effort to keep generally active. Your doctor may refer you to a physiotherapist who can take you through some exercises to continue at home, or your GP may give you a sheet of 'self physio' exercises.

Lots of other factors can cause back pain too, but the same principle applies to most kinds of back pain, whether caused by arthritis or anything else . Doctors used to recommend complete rest, but we now know that can do more harm than good. Keep as active as possible and build up your levels of activity gradually as your pain allows.

With thanks to 'My Weekly' magazine where this article was originally published.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.