The most common causes of pain

The real burden of pain

Musculoskeletal disorders are the world's leading cause of years lived with disability, and low back pain alone tops that list. About 20% of European adults live with moderate to severe chronic pain, and half of them feel that their pain is not adequately managed.

The conditions below are no substitute for a medical diagnosis: several disorders can produce very similar pain, and only a clinical examination can tell them apart.

Back and neck pain

Non-specific low back pain. More than nine cases in ten are “non-specific”: no serious underlying damage is involved. Early imaging is unhelpful and often counterproductive, because the changes it shows (disc degeneration, osteoarthritis) are very common in people with no pain at all. Treatment rests on staying active, simple painkillers for a short period and a gradual return to normal loading.

Sciatica and femoral nerve pain. When a nerve root is compressed, the pain travels down the leg along a defined path, with tingling or loss of strength. The great majority of disc prolapses settle within six to twelve weeks without surgery.

Neck pain. Closely linked to prolonged static postures, to stress and to a lack of movement. Strengthening and endurance exercises for the neck muscles work better than rest or a collar.

Headache and facial pain

Migraine. Attacks of headache lasting 4 to 72 hours, often one-sided and throbbing, made worse by exertion, with nausea, photophobia and phonophobia. It affects around 15% of the population, mostly women. Treatment combines acute medication (triptans, NSAIDs) and, when attacks are frequent, preventive treatment.

Tension-type headache. A band-like, bilateral, non-throbbing pain of mild to moderate intensity that is not made worse by exertion. The chronic form calls for a broad management plan rather than an escalation of painkillers.

Medication-overuse headache. A classic trap: taking painkillers on more than ten to fifteen days a month keeps the headache going. Supervised withdrawal is the only way out.

Trigeminal neuralgia. Lightning-like electric shocks across one side of the face, set off by speaking, chewing or the lightest touch to the skin.

Joint and muscle pain

Osteoarthritis. Mechanical pain: it comes on with activity, eases with rest and is accompanied by brief morning stiffness lasting less than thirty minutes. Knee, hip, hand and spine are the usual sites. Therapeutic exercise and weight management have stronger evidence behind them than most medicines.

Inflammatory arthritis. Pain that wakes you in the second half of the night, prolonged morning stiffness, a swollen and warm joint. Rheumatoid arthritis, axial spondyloarthritis, gout: early diagnosis changes the outlook, so do not wait.

Fibromyalgia. Widespread pain for more than three months, unrefreshing fatigue, poor-quality sleep and difficulty concentrating. The diagnosis is a clinical one. Graded, regular physical activity remains the best-evidenced treatment.

Tendinopathy. Shoulder, elbow, Achilles tendon: the pain arises from repeated mechanical overload. Rehabilitation with progressive loading exercises is the standard of care.

Nerve pain

Diabetic neuropathy. Up to one person in four with diabetes develops neuropathic pain, typically in a stocking distribution, symmetrical and worse at night. Blood glucose control and regular foot checks are essential.

Post-herpetic neuralgia. It follows about one in five episodes of shingles after the age of 60. Vaccination and early antiviral treatment of shingles clearly reduce that risk.

Chemotherapy-induced neuropathy. Platinum salts, taxanes and vinca alkaloids cause tingling and burning in the hands and feet, sometimes persisting after treatment has finished. Any such symptom should be reported to the oncology team without delay.

Carpal tunnel syndrome. Compression of the median nerve at the wrist: night-time tingling in the first three fingers, waking, clumsiness. A night splint, a steroid injection or surgery, depending on severity.

Abdominal, pelvic and visceral pain

Renal colic. Sudden, unbearable one-sided loin pain radiating to the groin, with no position that relieves it. A medical emergency, particularly if there is fever as well.

Endometriosis. It affects roughly one woman in ten of reproductive age. Very painful periods that do not respond to ordinary painkillers, pain during sex, chronic pelvic pain and sometimes infertility. Diagnostic delay is still measured in years: periods that stop you going to work or to school are not normal.

Irritable bowel syndrome. Recurrent abdominal pain related to opening the bowels, with bloating and irregular transit, and no structural disease. A textbook example of visceral hypersensitivity.

Pain related to cancer and to surgery

Cancer pain. It affects one patient in two during the illness and up to eight in ten in advanced disease. Often mixed in mechanism, it calls for regular assessment, round-the-clock background treatment and rescue doses planned in advance. In the very great majority of cases it can be relieved effectively.

Chronic post-surgical pain. It persists beyond three months after the operation in 10 to 50% of patients, depending on the type of surgery (thoracotomy, mastectomy, hernia repair, amputation). Effective pain relief in the first hours after surgery reduces that risk.