When people consult the doctor they do so because they have had feelings and sensations that are disturbing and uncomfortable. Perhaps they have had reactions in various portions of the body which are quite different from the usual. For instance, symptoms may include pain, weakness, shortness of breath, cough, or itching. One may notice a sudden increase of weight, or loss of weight. The hands and feet may seem to be cold and numb. Indigestion may occur, with dizziness or vomiting or diarrhea. Because of jaundice the skin may develop a yellow appearance. All these are included in the signs and symptoms of disease; they are a warning that an investigation of the cause is needed.

People who are emotionally disturbed are likely to feel pain sooner and more intensely than are people in general. With the reaction to pain may come other changes, brought about through functioning of the sympathetic nervous system. These include rapid beating of the heart, sweating, rise in the blood pressure and disturbances of digestion.

Pain

Pain is described as burning, sticking or pricking, sharp, dull, throbbing or knifing. Different parts of the body feel pain in different ways. The skin reacts easily. Muscles may not feel puncture by a needle, but ache when they are in spasm or suffer cramp. Compact bone may be cut without pain but porous bone may be painful when injured. The brain tissue may not be sensitive, but the blood vessels have nerve connections and anything that pulls or stretches the blood vessels in the brain will give a pain in the head. Pain from the intestines may be due to injury of the intestinal wall, stretching of the muscles in the wall or pulling on the tissues that hold the intestines in place.

Headache

When you have a headache the doctor will want to know about the location of the pain, its quality, its intensity, the time when it comes on, and the way it is influenced by moving, reading, noise, and other factors. Usually a headache is a dull, aching pain, that arises from the structures within the skull. Sometimes a headache may be associated with a disturbance in the sinuses, or the eyes, or in the bones in the upper part of the spine.

Sensitivity to pain in the head varies in different people and in the same person at different times. The worst headaches are those associated with inflammations or infections of the meninges, which are the tissues that cover the brain. When a sudden, sharp pain affects the head the sensation may be due to a branch of the facial nerve. Usually headaches last longer, for minutes or even hours. When the headache is described as "throbbing" the effect comes from transmission of the pulse in the blood vessels.

A headache may be associated with exposure to cold. Other headaches may develop in healthy people during periods of great fatigue or emotional stress. Such headaches occur towards the end of the day; they begin as a dull ache in the forehead and spread towards the temples or towards the back. These headaches disappear when the person concerned has some good rest or sleep. Fear and worry seem to make headaches worse. Some headaches come from tenseness of the facial muscles, which in turn may be caused by pain or anxiety or strain.

Psychological disorders or mental disturbances may also be reflected in pains which are referred to the head. Such people complain of pressure on the head, of a tight-fitting band which squeezes the head, or of a pain that presses on the very top of the head.

Pain In The Chest

Pain in the chest may come from the ribs and the tissues related to the ribs; from organs in the abdomen; from the heart or from other organs in the chest. The muscle of the heart has to have oxygen, and when this essential is not provided the muscle responds with pain. Angina pectoris is a pain of this type which is usually continuous and which is provoked by walking, or an emotional strain, or any other factor that increases the work of the heart. The pain tends to be relieved when the burden is removed. Interference with the flow of blood carrying oxygen through the coronary arteries into the heart will bring on an attack of pain. The pain of angina pectoris and that of coronary thrombosis are about the same. Usually that of coronary thrombosis is more severe and lasts longer. Occasionally, however, thrombosis may occur with little or less severe pain.

Other pains in the chest may come from disturbances of the large blood vessels, from the nerves that reach the linings of the chest cavity, and from growths or abscesses behind the breast bone.

Heartburn probably arises from constriction at the bottom of the esophagus or swallowing tube, because material has been regurgitated from the stomach into this tube.

Pain In The Back

Strangely, one of the most difficult of all the diagnoses that a doctor has to make concerns the cause of a pain in the back. Excluding the pain that comes with breaking the bones of the spine or twisting the spine completely out of line, a number of different conditions may be ( responsible for different kinds of pains in the back. Infections may attack the tissues of the back as they do other parts of the body. Rheumatoid arthritis may select the many joints of the backbone as a place in which to locate. The little cartilages or discs that act as cushions between the bones may be crushed or slip out of place. The ligaments which attach to the bones of the spine may be pulled to the point where they are painful with every movement.

Careful study by an experienced physician reveals the cause of pain in the back and indicates the type of treatment to be followed. This may vary from changing the shoes and wearing a specially designed brace or corset, to instructions for reducing weight, improving the posture or even a surgical operation.

A recent postural instruction says:

• When standing or walking, toe straight ahead and take most of your weight on the heels.

• Sit with the buttocks tucked under so that the hollow in the low back is eradicated.

• When possible elevate the knees higher than the hips while sitting.

• Sleep on your back with your knees propped up or on your side with one or both knees drawn up.

• Bed should be firm.

• Never bend backwards.

• Avoid standing as much as possible.

• Learn to live 24 hours a day without a hollow in the lower part of your back.

• Avoid sleeping on the abdomen.

Painful Arms And Legs

Bums, frostbite, and cutting of the arms and legs may be painful. Similarly arthritis, abscesses in the bones and soft tissues, tumors and damage to the nerves may result in severe pain.

From the limbs of the body the nerves pass along until they connect with the roots in the spinal cord. Pressure, irritation or damage to these nerves at any point along their course may result in pain that is felt in the limb itself.

Pain may also be transmitted to the limbs from impulses arising elsewhere in the body. For instance, pain from the hip may be transmitted to the knee. Pain from the deep muscles of the back or from the small bones of the spinal column may be felt in the legs. Pain from angina pectoris or coronary thrombosis of the heart may be felt along the inner sides of the arms.

Various disturbances of the blood supply to the limbs may result in pain. This applies particularly to blocking of the circulation so that the tissues do not receive a proper amount of oxygen. As the blood supply becomes blocked there is a feeling of numbness and finally difficulty of movement. You say "My leg has gone to sleep." Blocking the blood to the arm causes the fingers to get quite numb in about twelve minutes, and then they are painful when touched. As the blood returns a sensation of tingling is felt, which is due to renewed activity of the nerves of the arm. If an arm or leg is moved while the circulation is blocked severe pain may be felt. This may be called a cramp, although actually the muscles are not in spasm but flaccid.

After a limb has been amputated pain may be felt as if it were in the limb. This is called "phantom limb" pain. In diagnosing the causes of pain in the extremities the character and location of the pain are most significant.