Trying to determine the best route to take when you're in pain is both confusing and stressful. It is helpful, however, to put the pain in context of any underlying health conditions, risk factors, or triggering events.
Summit Health internist, Dr. Susan Rubino, says, “Being able to describe your pain characteristics as well as recognizing any associated symptoms and understanding the potential risks can assist in determining your next step—whether that be visiting your primary care doctor or a specialist, going to urgent care, or heading directly to the emergency room.”
“The duration of your pain is also telling, whether it is progressive, intermittent, chronic, or acute onset,” says pain management physician, Dr. Joanne Owsiak adding, “It is also helpful to identify aggravating and relieving factors—what makes the pain better or worse, if is it associated with position, activities, or something else.”
Both Drs. Rubino and Owsiak emphasize that intense pain that comes with symptoms such as fever, nausea, and dizziness should be addressed immediately in an emergency care setting. But if the pain is not creating high distress or concern, your first step might be to check in with your primary care provider with an office or virtual visit, where a review of symptoms can help determine potential risks and how your pain should be managed.
Below, Drs. Rubino and Owsiak outline the best steps to take when dealing with different kinds of pain.
Chest pain can stem from various systems including musculoskeletal (rib strain or inflammation), gastrointestinal (acid reflux), or respiratory (bronchitis or pneumonia) to more serious causes such as cardiac (angina or heart attack). Classic symptoms of cardiac chest pain include radiation to the arm, jaw, or shoulder blade, and associated shortness of breath, sweating, dizziness, palpitations, nausea, and worsening upon exertion. If you experience any of these symptoms you should seek emergency care immediately.
It is often difficult to identify the exact cause of the pain. If pain follows a chest injury and worsens with movement, it is likely to be of musculoskeletal origin. If the pain is accompanied by shortness of breath, dizziness, palpitations, and increases with exertion, you should seek evaluation by your provider soon.
Burning pain in the chest, especially after eating, can be due to heartburn or acid reflux. However, cardiac pain can mimic heartburn. Pain that is limited to one area of the chest and gets worse when you put pressure on that area, is likely related to your rib cage or muscles.
Chest pain associated with a cough and fever may be due to infection such as bronchitis or pneumonia.
Though there are many reasons for chest pain, a heart attack can also manifest in various ways. “Therefore, anyone with risk factors for cardiovascular disease or who is unsure of the cause, should seek immediate care if they are experiencing sudden chest pain,” says Dr. Rubino. " This is especially the case if it's accompanied by dizziness or shortness of breath,” adds Dr. Owsiak.
Arm pain can be caused by injury to the muscles, tendons (fibrous end of the muscle that attaches to the bone), ligaments (fibers that join bone to bone), bursa (small fluid sac that protects other tissues), or bones. If pain after injury is mild, you can treat it with ice, rest, and elevation. If the pain gets worse or doesn’t resolve over a few days, you should seek medical evaluation. For severe pain, seek medical attention more urgently.
Pain upon movement of a joint (such as the shoulder, elbow, wrist, or finger) that develops over a week or several months may be a sign of arthritis or other joint issues. Your provider can help determine the root cause and develop a management plan. “Other arm pain in someone who has history of arthritis or that is accompanied by sharp neck pain, numbness, or weakness may be a symptom of a nerve compression and can be evaluated in a primary care or pain management office setting,” says Dr. Owsiak.
While arm pain may not seem alarming, both
Drs. Owsiak and Rubino agree pain in either arm that is not caused by a specific injury, could be a sign of a heart attack. If the pain is associated with chest tightness, shortness of breath, jaw or shoulder blade pain, or dizziness, you should head directly to the emergency room. As with chest pain, if there is any doubt, seek medical care immediately.
Eye pain can be caused by a foreign object such as sand, infection or inflammation, allergies, or more serious illnesses such as blood clots or nerve damage. If you have a sensation that something is scratching your eyeball when you blink, you may have a foreign object on the cornea. Itchy, red, or watery eyes may be caused by conjunctivitis (infection of the lining of the eyeball) or allergies. Your primary care provider can help manage conjunctivitis or seasonal allergies.
If these symptoms are associate with more severe pain, "the best possible doctor to see is your ophthalmologist," says Dr. Rubino.Seek immediate attention if eye pain is severe or accompanied by headache, nausea, vomiting, fever or sensitivity to light. You should go to the emergency room if you have sudden loss of vision or if your vision changes suddenly. Sudden halos or floaters in your vision could be as sign of detached retina and should be treated immediately.
The most common causes of muscle pain are tension, stress, overuse, and minor injuries. "Muscular pain doesn't always have to be worrisome if you know what it stems from," says Dr. Owsiak. "For example, if you just ran a marathon." It doesn't require rushing to the emergency room or urgent care, unless, she points out, it comes with other symptoms such as nausea or fever. Systemic muscle pain—pain throughout your whole body—is more often the result of an infection, an illness, or a side effect of a medication. Causes of muscle pain include flu, COVID-19, Fibromyalgia, Lupus, and Lyme disease among others.
Mild aches and pains without other symptoms can be managed with rest, heat or ice, and observation. If they do not improve, get worse, or are associated with other symptoms such as fever, joint swelling, changes in appetite, or other non-muscular problems, you should see your doctor to determine the cause and management plan.
The origin of abdominal pain can be superficial such as the skin or muscles of the abdominal wall or deeper from any of the organs in the abdomen or pelvis. Dr. Rubino notes that extreme abdominal pain, when accompanied by fever, nausea, bloody vomiting, blood in the stool, or black tarry stool indicates a need to go straight to the emergency room. Milder pain and low-grade fevers associated with non-bloody diarrhea or vomiting is likely to be from self-limited infections and can be managed with hydration and watchful waiting. Pain associated with meals may be related to reflux disease, gastritis, or gallstones. Lower abdominal pain may originate from the bladder, ovaries, or colon. Any pain, even if mild, that persists should be evaluated by your provider. “Intermittent abdominal pain without alarming progressive symptoms can be evaluated in my office,” says Dr. Rubino.
Headaches are most commonly caused by tension or stress. Tension headaches are usually bandlike around the temples or in your neck and shoulders. Migraines are more severe, often one-sided, and can be associated with nausea, light sensitivity, and may improve with resting in a quiet dark room. Other common causes include dehydration, caffeine withdrawal, and sinus congestion. Dr. Rubino says, “Keeping a headache diary and identifying triggers can be helpful, and a plan of care can be made with your primary doctor, including discussion of imaging and medication.” On rare occasion, a headache can be a sign of more serious problems such as meningitis, aneurysm, or brain tumors. You should seek immediate medical attention if your headache is unusual, severe, or disruptive. "Is this the worst headache of your life?" asks Dr. Rubino. "Then go directly to the ER." Another reason to seek immediate care is if the headache is associated with fever, neck stiffness, or any neurologic changes such as weakness, difficulty speaking, or drooping of the face occurs.
Neck and Back Pain
“Neck and back pain are among the most common problems seen in a primary care setting,” says Dr. Rubino. Most often it is due to strain, arthritis, or even degenerative disc disease, which can be evaluated in office.”
As a pain management physician, Dr. Owsiak’s main concern is that something could be putting pressure on the spine. If the pain is new or intense, or associated with “red flag symptoms” such as motor weakness, sensory loss, acute loss of urine or bowel control, saddle anesthesia (loss of sensation in the part of the body that makes contact with a horse saddle) or fever, she recommends going to the emergency room. Otherwise, if it is pain that has slowly increased over time, the best place to start would be a primary care doctor who can refer you to a specialist.
Any neck or back pain related to a specific traumatic injury should be evaluated immediately. And neck stiffness that is associated with fever requires immediate medical attention.
Dr. Rubino points out that your primary care physician (PCP) plays an important role in diagnosis. "Your PCP knows your history and underlying health conditions," she says. "So they are better equipped to understand your symptoms in the context of your individual risk profile." Additionally, a primary care doctor is at the ready to refer you on to a specialist like Dr. Owsiak if the situation requires.