Pain Alerts: Decoding the Warnings of Diseases

Dr. FUNG Ka Hang, Timothy

HKSH Resident Medical Officer

In general, the definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

The well-known proverb “No pain, no gain” is often used to motivate people by reminding them that hard work will lead to a reward. However, for patients dealing with pain from illness, the reality is not gain but rather anxiety, discomfort, and embarrassment, which greatly impact their daily lives and can even pose a threat to their well-being.

Family doctors are the primary protectors of patients’ health, regularly encountering individuals experiencing pain in various areas of their bodies. We determine the source of pain by evaluating the patient’s medical history and conducting appropriate tests, particularly if there are concerns about serious illnesses like cancer or chronic diseases, which may necessitate blood tests and imaging exams. Additionally, we take into account the patient’s medication, recognising that certain medications may result in pain and discomfort as a side effect.

It is crucial to pay close attention to situations where the body experiences pain without any obvious trauma. Some examples include acute glaucoma causing eye pain, cerebral haemorrhage or cranial thrombosis causing severe headaches, acute myocardial infarction causing chest pain, vascular rupture causing chest/abdominal pain or accompanied by dizziness, and ectopic pregnancy causing abdominal pain. By highlighting some cases as below, we hope to raise awareness of the signals of pain and the importance of seeking early medical attention.

Persistent Hand Pain: Arthritis Suspected

A young woman in her thirties presented with hand pain in multiple fingers in both hands, as well as morning stiffness. Despite attempting to alleviate the pain with simple analgesics and avoiding overuse of her hands, the pain persisted. Physical examination revealed no apparent trauma or joint deformity, but blood tests confirmed the presence of a rheumatic disease factor. Upon consultation with a rheumatologist, she was diagnosed with rheumatoid arthritis. With the latest medication treatment and targeted intervention, her condition has gradually improved, preventing further joint damage and disabling hand deformities.

Shoulder Pain at Aged 50

A man in his late forties endured months of shoulder pain, tenderness, and stiffness with no apparent cause. Despite trying various over-the-counter pain relievers and patches, all attempts were ineffective. Seeking medical assistance, the doctor ruled out serious bone and joint diseases and the need for surgery due to the absence of fractures or red flags. The diagnosis was frozen shoulder, and the patient was prescribed topical and oral pain relievers that significantly reduced his discomfort. Along with physical and occupational therapy, the patient’s shoulder pain notably decreased after several months. The doctor closely monitored the patient’s condition and noted occasional recurrence of shoulder and neck pain. Clear advice was provided to improve posture and prevent further shoulder pain. The patient was also informed that a referral to orthopaedic or other specialised doctors would be necessary if the condition worsened.

Headaches Accompanied by Vomiting

A patient in his sixties, who has regularly participated in outdoor activities such as hiking and marathons, experienced sudden, severe headaches and vomiting. After a thorough examination, including an eye pressure test which showed a pressure of 29, he was diagnosed with acute glaucoma. He was referred to an ophthalmologist and underwent prompt intervention. Early medical attention is important as glaucoma can rapidly lead to blindness.

Stomach Pain Signals Heart Trouble

A patient in his seventies has had long-term hypertension, early-stage diabetes, and high levels of bad cholesterol. He came to seek medical help for stomach pain, accompanied by mild vomiting and even vomiting blood. The doctor suspected that it was a heart attack. After an electrocardiogram, he was diagnosed with an inferior heart attack and immediately referred to a cardiologist. A heart attack does not always manifest as chest pain. About 30% of heart attack patients present atypical symptoms such as tooth pain, headaches, shoulder and neck pain, sore throat, inner arm pain, upper abdominal pain, and lower limb pain. Seeking medical attention promptly is important for early recognition and treatment of a heart attack.

Chronic Pain Syndrome (CPS)

It is common for some patients to report experiencing pain on a daily basis, despite not having any physical ailment. We will provide them with attentive care, as we seek to understand whether their emotional distress could be manifesting as unexplained physical pain. It is better for patients to bring acute pain to our attention rather than suffering in silence, as this can lead to a chronic situation. By addressing their pain instead of ignoring it, they are preventing the development of a chronic condition.

Chronic Pain Syndrome (CPS) is defined as the experience of pain for a minimum of 3 months and a duration of over 6 months, accompanied by symptoms such as depressed mood, poor sleep quality, fatigue, reduced activity levels, and libido. Some patients may also exhibit excessive use of drugs and alcohol, dependency behavior, and significant loss of physical function, such as complaining of weakness in walking or being unable to lift their hand to brush their teeth even without injury.

CPS is a common set of symptoms in clinical settings, often stemming from a complex combination of causes and impacting physical function, emotional well-being, as well as work, marriage, and family. Teenagers can be affected by their parents’ long-term pain, leading to anxiety and depression. It is important to recognise that individuals with chronic pain or a predisposition to depression are at a heightened risk of suicide. An optimal approach to addressing CPS involves providing integrated treatment to enhance the overall well-being of patients suffering from pain.

It is crucial to acknowledge that while pain is an inevitable part of life, it can also serve as an important signal for the body to seek appropriate treatment and minimise its impact. Patients are encouraged to consult with their family doctor to find effective ways to manage pain.