Surprising Causes of Pain case study

Good advice for aches, pains & injuries

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Drawing of a knob representing the intensity of back pain, dialed up to 11.

There are many paths to pain that never makeheadlines.

34 Surprising Causes of Pain

Trying to understand pain when there is no obvious explanation

,Sep 5, 2019

The world is full of unexplained pain, with many dozens of possible causes. By far the most important thing to understand about treating chronic pain is that it is difficult because it almost never hasonecause: it is extremelymultifactorial.Its always a game of Whac-A-Mole with chronic pain but some (and well-camouflaged too).

I publish a busy website about pain, and so I get email like this more often than I change my socks:

Ive been to every medical specialist you can imagine. They cant find anything wrong with me. The psychiatrist says its not in my head, and the rheumatologist says its not in my body. Butsomethingis causing my pain. Its not an infection or a fracture or a cancer. Its not a sprain or a pinched nerve or a cattle prod. What else is there? What else isleft?

What else indeed? When obvious and known causes of pain have been eliminated,what next?What else causes pain? How else can pain start, change, worsen? This article summarizes 34 of the to hurt, the things that might help you understand pain that has defied diagnosis or explanation so far. There are a lot more possibilities, but its a start, and this article hopefully focusses on the most important.

A lot of pain is unexplained

The official causes of all kinds of chronic pain break down into three roughly equally large categories, plus one small other category:

injury (38%)

unknown (31%)

musculoskeletal (24%), a vague category dominated by arthritis, the rheumatic diseases, and headache

other (7%), which is mostly cancer and abdominal pain plus everything else (mostly pain related to major physiological systems)

Misdiagnosis is routine, of course. Arthritis and the rheumatic diseases should probably be in their own major category, and almost everything else filed under unknown. Pain after injury is surprisingly murky: sure, it might have started with an injury, but two years later is that still the cause? It has usually transmogrified into something else, and exactly how that works is much more about the unknown than injury. Many cases of chronic pain are hard to put in just one of these categories (or they onlyseemeasy to place). As you browse around this article, youll notice that most causes of pain are hard to categorize.

Table of Contents

Basic mechanisms, processes, and concepts (potentially relevant to many injuries or illnesses, and a lot of these overlap partially or even completely):

And some specific pathologies (things that can be diagnosed, and in some cases treated)

Fibromyalgia?By definition, fibromyalgia isunexplainedchronic widespread pain. It is not in itself a cause of pain. Read.

, especially and probably intermittent)

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