You develop really bad back pain for the first time in your life. It’s a complete shock, because you’re in your mid 30’s and you’ve never been the type to have back problems, or pain problems in general. It feels a bit like there’s yet another thing going wrong with you, because you’ve been feeling run down and losing weight.
The pain is very persistent and a lot worse at night. After a week or so it gets a lot worse and you are awake in pain for most of the night. At that point you decide it’s definitely time to call your doctor.
You tell your doctor what’s going on and he looks a little concerned. He asks if you have been sweating a lot at night or lost any weight. You tell him that you have been sweating, and that you’ve lost about 5kg but you’re not sure why.
Long story short… it turns out you have skin cancer that has spread to your spine.
‘Disease pain’ is sinister pain that mimics regular musculoskeletal pain, but is actually revealing something far more serious.
In pain management we have a concept known as red flags. Ref flags are signs and symptoms that something more serious could be wrong with the patient. A red flag doesn’t mean for sure that there’s something seriously wrong, it could be an anomaly. But a red flag is always something you’re going to investigate further.
There are many disease states that can put up a red flag – inflammatory arthritis, joint and bone infections, trauma, cancer and internal organ disease are all important examples.
Classical red flags when you are diagnosing pain issues include symptoms like weight loss ,night sweats, night pain, specific organ symptoms, unusual headaches – and also symptoms of spinal cord compression.
There are many complex ways that disease can mimic less sinister type pain. One of the most common is through ‘referred pain’. Internal organ disease can create referred pain to the joints, extremities and spine. The one example that sits in the realm of common knowledge is the heart attack that manifests as left arm pain.
If you have undiagnosed issues with your bowel and bladder, bad pain at night, unintentional weight loss, night sweats, unexplained low energy, nerve symptoms – or basically any other unexplained symptoms: get checked out by a professional.
Take some reassurance from the fact that routine investigations like scans and blood tests are a very reliable way to know if something is amiss in the majority of pain cases.
Mainstream healthcare may not be great at biomechanics and psychosomatics- but it is very good at diagnosing serious diseases!