What could be causing my pain?

What Could Be Causing Your Pain?

Your pain requires immediate systematic evaluation to exclude life-threatening conditions first, then identify the specific cause based on location, character, timing, and associated symptoms.

Critical Life-Threatening Causes to Rule Out First

You need urgent evaluation if your pain has any of these features:

• Chest pain with shortness of breath, rapid heart rate - Could indicate pulmonary embolism, which presents with dyspnea, pleuritic chest pain, tachycardia, and tachypnea 1
• Sudden "ripping" chest pain radiating to the back - Suggests aortic dissection, with pulse differences between arms in 30% of cases 1
• Sharp chest pain that improves sitting forward, worsens lying down - May indicate pericarditis, which shows widespread ST-elevation with PR depression on ECG 1
• Chest pain with fever, productive cough - Could be pneumonia with pleuritic pain, regional dullness to percussion, and possible friction rub 1
• Sudden chest pain with absent breath sounds on one side - Classic for pneumothorax, characterized by dyspnea, pleuritic pain, and hyperresonant percussion 1

A critical pitfall: 13% of patients with sharp, pleuritic chest pain actually have acute myocardial ischemia, and 7% of patients with reproducible chest wall tenderness have acute coronary syndrome 1, 2. Never assume sharp pain or tenderness on palpation excludes cardiac disease.

Common Non-Life-Threatening Causes

Musculoskeletal Pain (Most Common)

• Costochondritis/Tietze syndrome - Tenderness of the costochondral joints on palpation, inflammation of cartilage connecting ribs to sternum 3, 4
• Muscle strain or spasm - Particularly pectoral muscles, worsens with movement 3, 4
• Rib fracture - Most common in ribs 3-8, presents with localized pain worsening with breathing or palpation 4
• Nerve entrapment - Especially the lateral cutaneous branch of the third intercostal nerve 3, 4

Breast Pain (If Female)

• Cyclical mastalgia - Bilateral, diffuse, related to menstrual cycle, affects women in their 30s, spontaneous resolution in 14-20% within 3 months 3
• Noncyclical mastalgia - Unilateral, focal, precisely localizable, more common in women in their 40s, inflammatory rather than hormonal 3
• Mastitis or breast abscess - Focal pain preceding induration, redness, warmth, and fever 3

Gastrointestinal Causes

• Gastroesophageal reflux, peptic ulcer disease, esophageal disorders - Account for 10-20% of chest pain in outpatients 4
• Gallbladder pathology - Can refer pain to chest area 3

Other Causes

• Herpes zoster - Dermatomal distribution pain triggered by touch, with characteristic unilateral rash 1
• Fibromyalgia or fibromyositis - Widespread musculoskeletal pain 3

Essential Initial Evaluation

You need these tests immediately if presenting with acute pain:

• ECG within 10 minutes - To identify STEMI, pericarditis patterns, or pulmonary embolism signs 1
• Chest X-ray - To evaluate for pneumothorax, pneumonia, pleural effusion, or widened mediastinum 1
• Cardiac troponin - Measured as soon as possible to exclude myocardial injury 1

Specific Features That Guide Diagnosis

Pain Character

• Sharp, stabbing, "knifelike" worsening with breathing - Pleuritic pain from pleural inflammation, pneumonia, or pulmonary embolism 1, 2
• Pressure or heaviness - More typical of anginal pain from coronary artery disease 2
• Creaking leather sound with breathing - Pleural friction rub indicating pleural inflammation 2

Pain Location

• Subareolar or nipple area, lower inner breast - Noncyclical mastalgia requiring evaluation to exclude breast lesion 3
• Lateral rib area - Rib fracture, costochondritis, or nerve entrapment 4
• Reproducible with chest wall palpation - Suggests musculoskeletal origin but does NOT exclude serious pathology 1

Associated Symptoms

• Fever - Pneumonia, mastitis, or pericarditis 1
• Shortness of breath - Pulmonary embolism, pneumothorax, or heart failure 1
• Redness, warmth, swelling - Mastitis or cellulitis 3

Immediate Action Required

Seek emergency care immediately if you have:

• Chest pain with shortness of breath, rapid heart rate, or sweating 1
• Sudden severe chest pain radiating to back 1
• Chest pain with weakness, slurred speech, or facial swelling 5
• Chest pain with fever and productive cough 1

Pain Management While Determining Cause

For non-emergent musculoskeletal pain:

• Ibuprofen - Use at lowest effective dose for shortest time needed; avoid if history of ulcers, bleeding problems, or heart disease 5
• Acetaminophen - Stop and seek medical attention if pain worsens or lasts more than 10 days 6

Critical warning: Do not use pain relief as a diagnostic test. Nitroglycerin response does not confirm or exclude myocardial ischemia 1.