Pain Archive

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Unlocking the mystery of chronic pelvic pain syndrome

The condition is an all-too-real problem for men, and one of the more difficult to treat.

After age 50, men often have periods of discomfort "down there." It could be a cramping, aching, or throbbing pain in and around your pelvis and genitals. You also may have issues in the bedroom and bathroom. While the problems are real, the cause is often difficult to pinpoint.

It's called chronic pelvic pain syndrome (CPPS) — also known as chronic prostatitis — and it's one of the most puzzling and difficult-to-manage conditions for older men.

When you take these popular pain relievers, proceed with caution

Over-the-counter and prescription drugs known as NSAIDs pose a risk to the cardiovascular system. They include over-the-counter drugs such as ibuprofen (Motrin, Advil) and prescription drugs such as celecoxib (Celebrex). NSAIDs can cause the kidneys to hold on to salt and water, which tends to raise blood pressure. They also appear to affect the inner linings of blood vessels and alter other blood substances in a manner that promotes blood clots. People who need these pain-relieving medications should take the smallest dose for the shortest possible period of time.

Diffuse Pain

We're sorry you have pain!

The word "diffuse" means "widespread" and refers to pain that is more or less all over, or at least in many areas. The goal of this guide is to provide information while awaiting evaluation with your doctor, or for additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The diagnoses provided are among the most common that could explain your symptoms, but the list is not exhaustive and there are many other possibilities. In addition, more than one condition may be present at the same time. For example, a person with rheumatoid arthritis could also have tendonitis.

Please click here to begin.

Do you have severe diffuse pain with fever, redness over the skin or joints, marked swelling, inability to use the muscles or joints, or recent significant trauma (a fall, car accident, etc.)?

Yes, I have one or more of the above.

No, none of these apply to me.

Foot Pain

We're sorry to hear you have foot pain!

Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The goal of this guide is to provide information while awaiting evaluation with your doctor or additional information after you have seen him or her.

Foot pain may develop for a number of reasons -- fracture and infection are among the most serious while sprains and arthritis are among the most common. There are rare causes of symptoms that will not be included here and would require more detailed evaluation than this guide can provide.

Severe pain, swelling, bruising, or inability to bear weight are "alert" symptoms that could indicate serious injury to a bone or ligaments. When accompanied by fever, an infection becomes a major concern. However, most people with foot pain have no serious or dangerous cause. In fact, many have pain due to poorly fitting or tight shoes; for women, high heels only make a tight shoe more uncomfortable. Try changing your footwear to something with more cushion, support and room for your feet -- and read on to learn more about the causes of foot pain.

Certain symptoms suggest a serious cause of foot pain that requires prompt attention. It's important to ask questions about these symptoms first.

Did your pain begin after a significant injury, such as a fall or car accident?

Yes, my pain began just after a significant injury.

No, my pain did not occur after a severe blow or injury.

Along with foot pain, have you noticed swelling or redness in your foot (or feet)?

Yes, I have noticed swelling and/or redness.

No, I have no swelling or redness, thank goodness!

Stress-induced brain activity linked to chest pain from heart disease

Research we're watching

Doctors have long known that mental or psychological stress can lead to angina (chest pain or discomfort caused by inadequate blood to the heart). Now, new research reveals a direct correlation between angina and stress-related activity in the brain's frontal lobe. The study included 148 people with coronary artery disease with an average age of 62. All underwent brain and heart imaging tests done in conjunction with mental stress testing, which involved mental arithmetic and public speaking. Imaging tests were also done under "control" conditions, which featured simple counting and recalling a neutral event. Researchers monitored the participants for angina during the tests; they also assessed angina rates again after two years.

Activity in the inferior frontal lobe area of the brain during mental stress was linked to the severity of self-reported angina, both during the brain imaging and at the two-year follow-up. A better understanding of how the brain reacts to stress may be an important consideration for doctors who treat angina, according to the study's lead author. The study was published online Aug. 10, 2020, by the journal Circulation: Cardiovascular Imaging.

Use topical painkillers for strains and sprains

In the journals

Hold off on taking pain pills to treat a sprained ankle, strained neck, or bruised knee. A new guideline from the American College of Physicians and the American Academy of Family Physicians recommends certain topical (gels, liquids or patches placed on the skin) painkillers as the first line of defense for musculoskeletal injuries in areas other than the lower back. The new guideline, published online Aug. 17, 2020, by Annals of Internal Medicine, was based on a review of more than 200 studies including a total of 33,000 patients with short-term injuries (pain lasting less than four weeks). It recommends using a topical nonsteroidal anti-inflammatory drug (NSAID) with or without menthol (which creates a cooling sensation). Topical NSAIDs come in gel, liquid, or patch forms; diclofenac gel (Voltaren Arthritis Pain) and aspirin cream are available without a prescription. Topical NSAIDs may have fewer risks than oral NSAIDs, which raise risk for stomach ulcers and bleeding, high blood pressure, kidney damage, and heart attacks. However, if topicals don't work, the guideline says you can move to oral NSAIDs such as ibuprofen (Advil, Motrin) or the non-NSAID painkiller acetaminophen (Tylenol); acupressure; or transcutaneous electrical nerve stimulation. The guideline recommends against using opioids such as tramadol (Ultram) except in severe cases.

Image: Victor_69/Getty Images

When walking leads to leg pain

Peripheral artery disease (PAD), which occurs when fatty deposits clog arteries outside the heart, is underrecognized and potentially dangerous. The hallmark symptom is leg pain that occurs with exercise, called intermittent claudication. PAD is more common among people who are older, who smoke, and who have diabetes. The recommended treatment involves short periods of walking interspersed with rest periods when pain occurs. Walking increases blood flow in the leg's smaller arteries and helps create new channels to move blood around the blockages; it also helps discourage new blockages.

What is chronic inflammation?

Ask the doctor

Q. I have suffered from rheumatoid arthritis for many years, and recently I also developed diabetes. My doctor says they are both related to inflammation. What is inflammation, and how can two such different diseases be connected to it?

A. Inflammation is both an old and a new idea in medicine. Roman physicians 2,000 years ago noted that wounds that were healing and joints that suffered from arthritis (like yours) became red, warm, swollen, and painful. It was like they were on fire: inflammare was the verb for setting on fire. But why did a wound become red, warm, swollen, and painful? They had no idea.

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