The worst type of pain? It's whatever pain you personally suffer from. But experts and patients agree: Certain medical conditions are especially excruciating. When health care providers ask patients to rate their pain on a scale from 1 to 10, these conditions -- whether acute or chronic -- can have some of them responding "11." If pain can't always be cured, proper treatment can at least help scale it back.
Trying to pass a kidney stone stuck in the urinary tract can bring people to their knees and straight to the emergency room. Usually made of calcium, these hard pellets block the flow of urine, making the kidney swell and causing waves of sharp pain at the mid-back, abdomen or sides and for men, pain at the end of their penis. Nausea, vomiting, fever and blood in the urine are common. Once a kidney stone is confirmed, treatment with IV fluid and medication allows the stone and the pain to pass. Stubborn small kidney stones may require shock wave therapy, or lithotripsy, to break them up. Larger or recurring stones may call for more complex methods.
For some women, intense pain in the lower back is an unforgettable aspect of childbirth. Often called back labor, the pain peaks during contractions and lingers in between, making it more difficult for women to push. It's sometimes caused by the baby's head position, with the back of the head pressing into the mother's tailbone, but that's not always the case. Non-medication methods to ease the mother's pain include moving away from a back-lying position, walking and applying counter pressure, for instance with a tennis ball or warm compresses, to the back. If these aren't enough, relief options include pain medication or an epidural nerve block using local anesthesia to numb the area.
With a gunshot wound or other trauma, sudden, severe pain can strike a healthy person to a degree they've never experienced, says Dr. Asokumar Buvanendran, an anesthesiologist specializing in pain medicine with Rush University Medical Center in Chicago. Acute pain provokes a variety of bodily signs, says Buvanendran, who is a past president of the American Society of Regional Anesthesia and Pain Medicine, or ASRA. Rising blood pressure, a racing pulse and cues from the patient's physique, movements and posture all tell the story of intense pain. But clinicians must rely on patients to gauge exactly how much pain they're in -- thus those requests to "rate your pain on a scale from 1 to 10."
Older adults who suffer from shingles may wish they'd been vaccinated against herpes zoster, the virus that causes chickenpox in kids and shingles in seniors. Besides rashes, blisters and scabbing, shingles patients suffer intense pain. This occurs in parts of the body along a nerve pattern, called the dermatome, where the virus resides -- often across the trunk. Unfortunately, some patients go on to develop a chronic condition called post-herpetic neuralgia, with symptoms including deep or burning pain, extreme sensitivity to touch and numbness in the affected area, which can last for years if not addressed promptly. Early treatment for shingles can help prevent the transition from acute to chronic pain, Buvanendran says. Your best bet to avoid shingles pain? Talk to your doctor about shingles vaccination if you're a healthy adult who's 50 or older.
No surprise here: Recovering from surgery can be painful. But some procedures cause more postoperative pain than others. Knee replacement surgery would rank near the top of the list, Buvanendran says, because of all the cutting through bone. However, he says, for whatever reason, the aftermath of hip replacement doesn't seem to hurt as much. But with every breath, lung surgery brings postoperative pain to the involved muscles, he adds.
As a source of agonizing back pain, an acute disc herniation -- possibly caused by heavy lifting -- is all too common. "Your disc protrudes and bulges and pushes on the nerve," Buvanendran says. "You have severe pain going down your legs." Many other people suffer from less dramatic but still-debilitating chronic back pain. The ASRA website offers a gamut of pain treatment options.
Major joint osteaoarthritis
When osteoarthritis invades your hips, knees or shoulders, every movement of those joints causes pain. Major joint osteoarthritis is one of the most common reasons patients come in seeking pain relief, says Dr. Mark Coleman, an anesthesiologist/pain management physician and president of clinical services for National Spine & Pain Centers and medical director for the center in Pikesville, Maryland.
Facet osteoarthritis involves the facet joints located in the rear of the spine. As cartilage between these joints wears out, padding between them is lost. The resulting bone rubbing on bone sounds bad and feels worse.
When osteoarthritis pain makes it difficult for people to even move, it puts them at risk for other serious medical conditions like heart disease. Pain and immobility can also contribute to mental health issues such as anxiety and depression.
Overall, 264 million days of work are lost to back pain every year nationally, according to a 2018 report from the United States Bone and Joint Initiative. "This is a huge problem," Coleman says. "And 80% of people at some time in their life are going to experience it."
Degenerative disc disease
Here's how patients describe severe back pain: "It's a gnawing, sometimes sharp-shooting pain that is unrelenting," Coleman says. "That keeps them up at night. That prevents them from engaging in activities of daily living, such as just standing to shave or brush their teeth. Or, certainly, carrying a bag of groceries up the steps can lead to having to lie down the rest of the day."
Back and neck degeneration, along with degenerative joint disease and spinal stenosis -- chronic pinching of the nerve that comes from ligament-thickening within the spine -- make up the bulk of back and spinal conditions that Coleman and colleagues see.
Fortunately, a spectrum of pain treatments is available. Epidural steroid injections, interspinous spacers and minimally invasive lumbar decompression are some options. Surgery is sometime indicated.
"There are also patients who've had multiple back surgeries such that they can't have any more surgeries who suffer from chronic pain," Coleman says. "We use neuromodulation or what we call 'dorsal column stimulation.'" For damaged nerve roots that cannot be operated on, "a minimally invasive, implantable stimulator device can block the pain -- it can jam the pain signal from going from the back to the brain. And we can give people long-term pain relief with that."
Sickle cell disease
Although it's classified as a rare disorder, sickle cell disease is well-known for the pain it causes. The inherited condition affects red blood cell formation. In sickle cell crisis, normally flexible and disc-shaped blood cells become stiff and crescent-shaped. Blood can't flow smoothly, which reduces delivery of needed oxygen to the body's cells. Pain management is an ongoing challenge for people with sickle cell disease, some of whom encounter acute pain during crises along with ongoing day-to-day discomfort.
"For now, pain management plays a supportive role when patients are in crisis so they don't have to go to the ER or urgent care," Coleman says. But stay tuned: "There is a lot of innovation going on the realm of hematology," he adds, with promising research in gene therapy to reduce sickle cell crises.
In endometriosis, tissue similar to that normally lining a woman's uterus grows outside her uterus. Ovaries, fallopian tubes and tissue lining the pelvis are most often involved. As with normal uterine tissue, this abnormal pelvic tissue is affected by hormones released with each menstrual cycle.
Cysts, irritation, scar tissue and adhesions -- abnormal bands that can make pelvic organs stick to another -- may result. Endometriosis pain can be particularly severe during menstrual periods and also cause discomfort during sex.
Getting an accurate diagnosis of endometriosis from an obstetrician-gynecologist is the first step to controlling pain. In combination with general pain relief methods, hormone therapies, surgery and pelvic floor physical therapy may help alleviate endometriosis pain.
Cancer bone pain
Bone pain from cancer can come directly from primary bone cancer itself or from bone metastasis -- cancer that has spread to the bone from the original disease site in the body. Breast, prostate, lung and kidney tumors are among the most likely to spread to the bone.
Treatment for cancer bone pain is multimodal -- involving a variety of methods to address pain at the source. Orthopedic surgery for weakened bones, radiation therapy to destroy cancer cells, and medications such as anti-inflammatories and steroids can reduce pain.
Supportive measures including acupuncture or acupressure, physical therapy, relaxation techniques, massage and counseling may also help relieve suffering from cancer bone pain.
Spinal headaches can result from an accidental tear or puncture made during a spinal tap procedure. Leaking of fluid from around the spinal cord can cause a severe spinal headache, Buvanendran explains. In some cases, he says, lifting heavy objects (like a fish tank for one patient) can cause a vulnerable spot to tear. Nausea, dizziness, light sensitivity and neck stiffness are symptoms. Doctors sometimes treat spinal headaches with blood patches from the patient's own blood to plug the leakage site.
They're not as sudden and sharp as spinal headaches. Even so, migraines can knock people out for days, notes Penney Cowan, founder and CEO of the American Chronic Pain Association. For this and other pain conditions, she says a balanced approach using a variety of therapies -- which will depend on the condition and patient -- is best. ACPA provides an A-to-Z rundown of treatments, including over-the-counter and prescription medications, acupuncture, complementary and alternative medicine, and cognitive behavioral therapy. With each individual, Cowan says, the goal is "to reduce their sense of suffering and improve the quality of their life and function."
Fibromylagia -- a disruptive, chronic condition -- causes body-wide pain, along with fatigue, mood and sleep problems. Fibromylagia, arthritis and Lyme disease are among dozens of chronic conditions addressed by the ACPA. "Pain is so isolating," Cowan says. "It makes you withdraw from everything and everybody." Pain management programs, offered by medical centers such as Cleveland Clinic, Johns Hopkins and Mayo Clinic, can make a big difference, she says. However, she adds, many people don't have access to these programs or can't afford them. With the current spotlight on opioid addiction risks, Cowan says, many chronic pain patients who have functioned well on these drugs for years are now being denied by doctors. See the ACPA site for in-depth information and options for chronic pain management.
Complex regional pain syndrome
After an arm or leg injury -- usually from fractures, surgery, sprains or immobilization -- some people experience excruciating, ongoing pain from trauma to their peripheral nerves, a condition called complex regional pain syndrome. In other cases of CRPS, the cause in never determined.
A CRPS diagnosis can be complicated. Oftentimes, specialists such as neurologists or orthopedists must weigh in. Nerve conduction studies, ultrasound, MRI or advanced bone scans using dye may reveal underlying bone nerve damage or bone abnormalities.
"Complex regional pain syndrome is a very rare and serious complication but there are treatments," Coleman says.
Don't give up.
Pain should be manageable, so don't give up on finding relief. In some cases of hard-to-treat pain, a pain specialist might be able to offer therapies beyond what's available from your primary care provider. "Oftentimes, patients get despondent about their painful conditions," Coleman says. "I encourage them to seek out a pain management physician to see what some of the newer interventions are. We're very good with degenerative diseases now: the spinal stenosis, the nerve pinching."
With great strides being made in such diseases, Coleman encourages people living in pain to persevere and seek a definitive diagnosis and effective pain treatment.
Most painful medical conditions
These acute or chronic conditions can cause severe pain:
-- Kidney stones.
-- Postoperative recovery.
-- Back injury.
-- Major joint osteoarthritis.
-- Degenerative disc disease.
-- Sickle cell disease.
-- Cancer bone pain.
-- Spinal headaches.
-- Complex regional pain syndrome.