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Last updated: September 21, 2025View editorial policy

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Differential Diagnosis for Severe Pain

  • Single most likely diagnosis
    • Acute abdomen (e.g., appendicitis, cholecystitis): This is a common cause of severe pain, especially if the pain is localized to a specific area of the abdomen.
  • Other Likely diagnoses
    • Renal colic (kidney stones): Severe pain, often radiating from the flank to the groin, is characteristic of renal colic.
    • Musculoskeletal injury (e.g., fracture, sprain): Trauma or overuse can cause severe pain in the affected area.
    • Migraine or other headache disorders: While often not as severe as other conditions, some headaches can cause debilitating pain.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Myocardial infarction (heart attack): Chest pain or discomfort can be a sign of a heart attack, which requires immediate medical attention.
    • Pulmonary embolism: Sudden onset of severe chest pain and shortness of breath can indicate a pulmonary embolism.
    • Aortic dissection: Severe, tearing chest pain can be a sign of an aortic dissection, which is a medical emergency.
    • Ectopic pregnancy: Severe abdominal pain in a woman of childbearing age can be a sign of an ectopic pregnancy, which requires immediate medical attention.
  • Rare diagnoses
    • Porphyria: A group of rare genetic disorders that can cause severe abdominal pain, among other symptoms.
    • Complex regional pain syndrome: A rare condition characterized by severe, burning pain in one limb after an injury or trauma.
    • Sickle cell crisis: Severe pain episodes can occur in individuals with sickle cell disease due to vaso-occlusive crises.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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