What are the possible causes of body pains in a patient with an unknown medical history and demographic?

Possible Causes of Body Pains

Body pains have multiple etiologies that can be broadly categorized into musculoskeletal (most common), neuropathic, inflammatory, and systemic causes, with musculoskeletal pain accounting for the majority of cases in primary care settings.

Musculoskeletal Causes (Most Common)

Musculoskeletal disorders represent the most frequent cause of body pain, accounting for approximately 43% of pain presentations in adults 1.

• Osteoarthritis and nonspecific pain are the predominant musculoskeletal causes, particularly affecting the back, neck, and joints 1
• Costochondritis presents as chest wall pain and is a frequent non-inflammatory musculoskeletal condition 2
• Fibromyalgia causes widespread musculoskeletal pain with fatigue, sleep disturbances, and memory problems, affecting approximately 14.6% of adults with chronic pain 1, 3
• Myofascial pain syndromes result from muscle tension, trigger points, and functional disorders 2

Neuropathic Pain

Neuropathic pain results from nerve injury or dysfunction and presents with characteristic "cold burning" sensations in a glove-and-stocking distribution 1.

• Peripheral neuropathy can be caused by diabetes, HIV infection, vitamin deficiencies (B6, B12, folate), thyroid dysfunction, alcohol use disorders, and certain medications including didanosine and zalcitabine 1
• Post-herpetic neuralgia following varicella zoster infection can cause incapacitating pain, especially in immunocompromised patients 1
• Complex regional pain syndrome (CRPS) typically follows minor injury and causes excruciating pain worsened by touch, with associated hair loss, tissue changes, and skin discoloration 1

Inflammatory Rheumatic Diseases

Inflammatory conditions cause pain through active inflammation and subsequent joint damage 4, 5.

• Rheumatoid arthritis causes multifactorial pain from both active inflammation and previous joint destruction 4
• Spondyloarthritis produces inflammatory back pain with characteristic morning stiffness 4
• Systemic lupus erythematosus can cause chest pain and widespread musculoskeletal symptoms 2
• Inflammatory bowel disease (Crohn's disease and ulcerative colitis) causes abdominal pain in 50-70% of patients during active disease, with pain persisting even during quiescence in some cases 1, 6

Central Sensitization and Chronic Pain

Chronic pain involves central nervous system changes that amplify pain signals beyond the original site of injury 5, 3.

• Central sensitization creates a "sensitized or hyperactive central nervous system" that increases the volume control on pain processing, leading to widespread pain even without ongoing peripheral damage 3
• Centralized pain occurs when central nervous system amplification is superimposed on peripheral pain sources, common in autoimmune disorders and osteoarthritis 3
• Chronic widespread pain develops through functional and structural CNS changes that reduce pain thresholds globally, not just at affected sites 5

Gastrointestinal Causes

Gastrointestinal disorders account for 10-20% of body pain presentations, particularly abdominal and chest pain 1.

• Gastroesophageal reflux disease causes chest pain that can mimic cardiac pain, often described as squeezing or burning 1
• Esophageal motility disorders (achalasia, esophageal spasm) present with retrosternal pain and dysphagia 1
• Peptic ulcer disease and gastritis cause epigastric pain, often related to NSAID use 1
• Irritable bowel syndrome frequently coexists with IBD and fibromyalgia, causing abdominal pain and altered bowel habits 1

Medication-Related Pain

Certain medications directly cause muscle and body pain through various mechanisms 7.

• Statins (HMG-CoA reductase inhibitors) can cause rhabdomyolysis, muscle fiber atrophy, and muscle necrosis by damaging muscle fiber membranes 7
• NSAIDs including ibuprofen cause gastrointestinal pain in 4-16% of patients, with higher rates at doses of 3200 mg/day 8
• Opioid medications paradoxically worsen pain outcomes in IBD and chronic pain conditions, with long-term use associated with poor outcomes and increased mortality 1

Metabolic and Systemic Causes

Metabolic disorders and systemic diseases produce diffuse body pain through various mechanisms 1, 7.

• Diabetes mellitus causes painful peripheral neuropathy with increasing prevalence among various populations 1
• Thyroid dysfunction contributes to both neuropathic and musculoskeletal pain 1
• Metabolic myopathies from disorders of carbohydrate, fat, or purine metabolism cause muscle pain and weakness 7
• Multiple myeloma can present with bone pain and neuropathic symptoms 1

Psychosocial Factors

Psychological factors significantly influence pain perception and chronicity 1.

• Depression and anxiety are more common in patients with body pain and worsen pain outcomes, particularly in IBD where they correlate with increased healthcare utilization 1
• Stress promotes disease flares in inflammatory conditions and amplifies pain perception 1
• Early-life adversity, trauma, and discrimination experiences increase risk of developing chronic pain 1
• Pain catastrophizing and poor coping styles predict transition from acute to chronic pain 1

Critical Red Flags Requiring Urgent Evaluation

Certain pain presentations indicate life-threatening conditions requiring immediate intervention 6.

• Pain out of proportion to examination findings suggests mesenteric ischemia with 30-90% mortality 6
• Severe abdominal pain with abrupt onset may indicate aortic dissection or ruptured abdominal aortic aneurysm (>50% mortality) 6
• Abdominal rigidity with peritoneal signs indicates perforated viscus requiring immediate surgical evaluation 6
• Fever with severe pain warrants CT imaging to exclude abscess, infection, or other serious pathology 6

Common Clinical Pitfalls

• Do not assume normal laboratory values exclude serious pathology, as values may be normal despite serious infection, especially in elderly and immunocompromised patients 6
• Avoid long-term opioid use as it is associated with poor outcomes, increased infections, and mortality in chronic pain conditions 1
• Recognize that pain can persist without active inflammation in conditions like IBD and rheumatoid arthritis due to central sensitization mechanisms 1, 3
• Consider fibromyalgia and central sensitization in patients with widespread pain who fail to respond to treatments targeting peripheral pain sources 3