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Migraines, Headaches, and Hormones

It has been estimated that 70% of migraine sufferers are female. Of these female migraine sufferers, 60%-70% report that their migraines are related to their menstrual cycles — hence the name, menstrual migraines.

What Is the Relationship Between Hormones and Headaches?

Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone estrogen during a woman’s menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow.

Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels.

Migraine attacks typically disappear during pregnancy. In one study, 64% of women who described a menstrual link to their headaches noted that their headaches disappeared during pregnancy. However, some women have reported the initial onset of migraines during the first trimester of pregnancy, with disappearance of their headaches after the third month of pregnancy.

What Triggers Hormonal Migraines in Women?

Birth control pills as well as hormone replacement therapy during menopause have been recognized as migraine triggers in some women. As early as 1966, investigators noted that migraines can become more severe in women taking birth control pills, especially those containing high doses of estrogen.

The frequency of side effects, such as headache, decreased in those who took birth control pills containing lower doses of estrogen and did not occur in those who took birth control pills containing progesterone.

What Are the Treatment Options for Menstrual Migraines?

The medications of choice to stop a menstrual migraine are nonsteroidal anti-inflammatory medications (NSAIDs).

The NSAIDs most often used for menstrual migraines include:

  • Orudis
  • Advil and Motrin
  • Nalfon
  • Naprosyn
  • Relafen

NSAID treatment should be started two to three days before the menstrual period starts and continue til the period ends. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.

For people who have severe menstrual migraines or who want to continue taking their birth control pills, doctors recommend taking a NSAID, starting on the l9th day of the cycle and continuing through the second day of the next cycle.

Other medications that may be used are given by prescription only. They include:

  • Small doses of ergotamine drugs (including Bellergal-S, Cafergot, Migranal)
  • Beta-blocker drugs such as propranolol
  • Anticonvulsants such as valproate (Depakote)
  • Calcium channel blockers such as verapamil

These drugs should also be started two to three days pre-menses, and continued throughout the menstrual flow.

Because fluid retention is often associated with menses, diuretics have been used to prevent menstrual migraine. Some doctors may recommend limiting salt-intake immediately before the start of menses.

Lupron is a medication that affects hormone levels and is used only when all other treatment methods have been tried and have been unsuccessful.

What Are the Treatment Options for Menopausal Migraines?

For people who need to continue post-menopausal estrogen supplements, the lowest dose of these agents should be used, on an uninterrupted basis. Instead of seven days off the drug, you should take it on a daily basis. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm) may also be effective in stabilizing the levels of estrogen.

What Are the Treatment Options for Migraines During Pregnancy?

During pregnancy, no treatment is recommended to treat migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these medications should be strictly avoided during pregnancy.

A mild pain reliever can be used, such as Tylenol. It is important that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists before taking anything.

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Migraines May Up Risk of Painful Skin

A new study shows migraine sufferers are more likely to have a type of pain condition called “allodynia” — pain from something that normally should not evoke pain, such as rubbing the head, combing hair, or wearing necklaces and earrings.

The study looked at questionnaire answers from 16,573 people who have headaches; 11,737 of them have migraines, 1,491 have probable migraines, and 3,345 have other types of headaches.

Researchers explored what types of headaches these people have and how often they get them, among other things.

When it came to allodynia, here’s what the researchers found:

  • 68% of respondents who had migraines every day reported allodynia.
  • 37% of those who had chronic daily headaches said they experienced allodynia.
  • In people with migraines, allodynia was more common in women and people who were obese.
  • Depressed people reported more extreme skin sensitivity and pain.
  • Extreme skin sensitivity and pain decreased with age.

Skin Pain and Headaches

Exactly what causes brain pain and extreme skin sensitivity? Researchers speculate that the constant activation of certain neurons in the brain may eventually damage those neurons, which could play a part.

Researcher Marcelo E. Bigal MD, PhD, from Albert Einstein College of Medicine in Bronx, N.Y., says allodynia may be a “risk factor for migraine progression, where individuals have migraines on more days than not.”

This type of pain and sensitivity seems to decrease as we age. Why? According to researchers, one reason may be that “the activation of pain pathways in the brain decline as attacks become less frequent and severe.”

Study researchers say identifying risk factors for how migraines progress can lead to better treatment. 

Researchers believe that there may be a link between female hormones and skin pain associated with headaches.

The study shows that the pain areas in the brain changed as women went through their menstrual cycle, with the most pain being reported during menstruation.

The study was sponsored by the National Headache Foundation and appears in the April 22 edition of Neurology.

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Common Pregnancy Pains and Their Causes

Your body is constantly changing now that you are pregnant, which may cause discomfort. Some pregnancy discomforts may occur in the early weeks, while others occur only as you get closer to delivery. Other pregnancy discomforts may appear early and then go away, only to come back later. This is normal and usually does not mean something is wrong.

Every woman’s pregnancy is unique, and some of the discomforts described in this article may not affect you. Discuss any concerns about pregnancy discomforts you are having with your health care provider.

Pregnancy Breast Changes

Most pregnant women will feel some changes in their breasts. Your breasts will increase in size as your milk glands enlarge and the fat tissue increases, causing breast firmness and tenderness in the first and last few months of pregnancy. Bluish veins may also appear as your blood supply increases. Your nipples will also darken and a thick fluid called colostrum may leak from your breasts. All of these breast changes are normal.

Recommendations:

  • Wear a bra that provides firm support.
  • Choose cotton bras or those made from other natural fibers.
  • Increase your bra size as your breasts become larger. Your bra should fit well without irritating your nipples. Try maternity or nursing bras, which provide more support and can be used after pregnancy if you choose to breastfeed.
  • To ease discomfort and maintain support, try wearing a bra during the night and day.
  • Tuck a cotton handkerchief or gauze pad into each bra cup to absorb leaking fluid. Nursing pads, which you can buy in a pharmacy, are also available. Make sure to change these pads as needed to prevent irritation to the underlying skin.
  • Clean your breasts with warm water only; do not use soap or other products since they can cause dryness.

Pregnancy Fatigue

Your growing baby requires extra energy, which may make you feel tired. Sometimes, feeling tired may be a sign of anemia (low iron in the blood), which is common during pregnancy.

Recommendations:

  • Get plenty of rest; go to bed early at night and try taking naps during the day.
  • Maintain a regular schedule when possible but pace your activities; balance activity with rest when needed.
  • Exercise daily to increase your energy level.
  • If you think anemia may be a concern, ask your health care provider to test your blood.

Pregnancy Nausea or Vomiting

An upset stomach is one of the most common discomforts during pregnancy. Nausea is a result of hormonal changes and most often occurs early in pregnancy until your body adjusts to the increased production of hormones.

Nausea can begin in early pregnancy, but is usually gone by the fourth month. It can occur at any time of the day but may be worse in the morning when your stomach is empty (this is often called “morning sickness”) or if you are not eating enough.

Recommendations:

  • If nausea is a problem in the morning, eat dry foods like cereal, toast or crackers before getting out of bed. Or, try eating a high-protein snack such as lean meat or cheese before going to bed (protein takes longer to digest).
  • Eat small meals or snacks every 2-3 hours rather than three large meals. Eat slowly and chew your food completely.
  • Sip on fluids throughout the day. Avoid large amounts of fluids at one time. Try cool, clear fruit juices, such as apple or grape juice.
  • Avoid spicy, fried, or greasy foods.
  • If you are bothered by strong smells, eat foods cold or at room temperature and avoid odors that bother you.
  • Talk to your doctor about taking vitamin B6 or other treatments.
  • Contact your health care provider if your vomiting is constant or so severe that you can’t keep fluids or foods down. This can cause dehydration and should be treated right away.

Pregnancy Frequent Urination

During the first trimester, your growing uterus and growing baby press against your bladder, causing a frequent need to urinate. This will happen again in the third trimester when the baby’s head drops into the pelvis before birth.

Recommendations:

  • Avoid tight-fitting underwear, pants, or pantyhose.
  • Contact your health care provider if your urine burns or stings. This can be a sign of a urinary tract infection and should be treated right away.

Pregnancy Headaches

Headaches can be caused by tension, congestion, constipation, or in some cases, preeclampsia . They can occur anytime during pregnancy.

Recommendations:

  • Apply an ice pack to your forehead or the back of your neck.
  • Rest, sit, or lie quietly in a low-lit room. Close your eyes and try to release the tension in your back, neck, and shoulders.
  • Try Tylenol (acetaminophen) occasionally. Ask your health care provider before taking any other medications for your headaches.
  • Contact your health care provider if you have nausea with your headaches, if your headache is severe and does not go away, or if you have blurry vision, double vision, or blind spots

 

Pregnancy Bleeding and Swollen Gums

The increase in your circulation and supply of certain hormones may cause tenderness, swelling and bleeding of gums.

Recommendations:

  • Take proper care of your teeth and gums. Brush and floss regularly.
  • Get a dental checkup early in your pregnancy to make sure your teeth and mouth are healthy. See your dentist if you have a problem.

Pregnancy Constipation

Your hormones as well as vitamins and iron supplements may cause constipation (difficulty passing stool or incomplete or infrequent passage of hard stools). Pressure on your rectum from your uterus may also cause constipation.

Recommendations:

  • Add more fiber (such as whole grain foods, fresh fruits, and vegetables) to your diet.
  • Drink plenty of fluids daily (at least 6-8 glasses of water and 1-2 glasses of fruit or prune juice).
  • Drink warm liquids, especially in the morning.
  • Exercise daily.
  • Set a regular time for bowel movements; avoid straining when having a bowel movement.
  • Discuss the use of a laxative with your health care providers; they may recommend natural fiber laxatives or stool softeners.

 

Pregnancy Dizziness (Feeling Faint)

Dizziness can occur anytime middle to late pregnancy. The pregnancy hormone progesterone dilates blood vessels so blood tends to pool in the legs. In addition, more blood is going to your growing uterus. This can cause a decrease in blood pressure, especially when changing positions, resulting in dizziness.

Faintness and dizziness can also be affected by poor eating habits. When your blood sugar levels are too low, you may feel faint.

Recommendations:

  • Move around often when standing for long periods of time.
  • Try lying on your left side to rest.
  • Try to move slowly when standing from a sitting position; avoid sudden movements.
  • Eat regular meals to prevent low blood sugar.

Common Pregnancy Pains and Their Causes

(continued)

Difficulty Sleeping During Pregnancy

Finding a comfortable resting position can become difficult later in pregnancy.

Recommendations:

  • Don’t take sleep medication.
  • Try drinking warm milk at bedtime.
  • Try taking a warm shower or bath before bedtime.
  • Use extra pillows for support while sleeping. Lying on your side, place a pillow under your head, abdomen, behind your back and between your knees to prevent muscle strain and help you get the rest you need. You will probably feel better lying on your left side; this improves circulation of blood throughout your body.

Pregnancy Heartburn or Indigestion

Heartburn (indigestion) is a burning feeling that starts in the stomach and seems to rise to the throat. It occurs during pregnancy because your digestive system works more slowly due to changing hormone levels. Also, your enlarged uterus can crowd your stomach, pushing stomach acids upward.

Recommendations:

  • Eat several small meals each day instead of three large meals.
  • Eat slowly.
  • Drink warm liquids such as herbal tea.
  • Avoid fried, spicy, or rich foods, or any foods that seem to give you indigestion.
  • Don’t lie down directly after eating.
  • Keep the head of your bed higher than the foot of your bed. Or, place pillows under your shoulders to prevent stomach acids from rising into your chest.
  • Don’t mix fatty foods with sweets in one meal and try to separate liquids and solids at meals.
  • Try heartburn relievers such as Tums, Maalox, Titralac, Mylanta, Riopan, or Gaviscon.

Pregnancy Hemorrhoids

Hemorrhoids are swollen veins that appear as painful lumps on the anus. They may form as a result of increased circulation and pressure on the rectum and vagina from your growing baby.

Recommendations:

  • Try to avoid constipation; constipation can cause hemorrhoids and will make them more painful.
  • Try to avoid sitting or standing for long periods of time; change your position frequently.
  • Make an effort not to strain during a bowel movement.
  • Apply ice packs or cold compresses to the area or take a warm bath a few times a day to provide relief.
  • Avoid tight-fitting underwear, pants, or pantyhose.
  • Discuss the use of a hemorrhoid treatment with your health care provider.

Pregnancy Varicose Veins

An increased volume of blood and the pressure of your growing uterus can slow your circulation, sometimes causing the veins in your legs to become larger or swollen.

Recommendations:

Although varicose veins are usually hereditary, here are some preventive tips:

  • Avoid standing or sitting in one place for long periods. It’s important to get up and move around often.
  • Avoid remaining in any position that might restrict the circulation in your legs (such as crossing your legs while sitting).
  • Elevate your legs and feet while sitting.
  • Exercise regularly.
  • Wear support hose but avoid any leg wear that is too tight.

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Low Back Pain - Medications

Low Back Pain - Medications

Medicine can decrease low back pain and reduce muscle spasms in some people. But medicine alone is not an effective treatment for low back pain. It should be used along with other treatments, such as exercise and physical therapy.

Medication Choices

There are several medicines your doctor may recommend, depending on how long you have had pain, what other symptoms you have, and your medical history. The medicines recommended most often are:

  • Acetaminophen.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Muscle relaxants.
  • Opiates.
  • Antidepressants.

Anesthetic or corticosteroid injections have all been prescribed for chronic low back pain, but they have not been researched enough to know whether they are effective for most people.

You may also hear of people having facet joint injections of anesthetic or corticosteroid for low back pain, but research has shown this to be ineffective or even harmful.

What To Think About

When making treatment decisions, bear in mind that medicines that work for some people don’t work for others. Let your doctor know if the medicine you are taking is not effective. There may be another option to help control your back pain.

Anticonvulsants are sometimes used to treat low back pain, even though there isn’t strong evidence that they help.

Botulinum toxin A (Botox) injection into the back muscles for chronic low back pain is an experimental treatment.

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What Is Back Pain?

We’ve all experienced back problems from time to time — a pain in the lower back or strain of the neck. In fact, problems from back pain are the most common physical complaints among American adults and are a leading cause of lost job time — to say nothing of the time and money spent in search of relief. Back pain includes sore muscles and tendons, herniated discs, fractures, and other problems. Most often, the causes of back pain have developed over a long period of time.

Back Pain: The Spine

The spinal column is an extraordinary mechanism. It keeps us stable enough to stand upright but flexible enough for movement. The backbone, or spine, is actually a stack of 24 individual bones called vertebrae.

A healthy spine is S-shaped when viewed from the side. It curves back at the shoulders and inward at the neck and small of the back. It’s the body’s main structural support. It also houses and protects the spinal cord, the intricate network of nerves that runs through the vertebrae to transmit feeling and control movement throughout the entire body.

What Causes It?

Back pain ranks high on the list of self-inflicted ailments. Most of our back troubles happen because of bad habits, generally developed over a long period of time. These include:

  • Poor posture
  • Overexertion in work and play
  • Sitting incorrectly at the desk or at the steering wheel
  • Pushing, pulling, and lifting things carelessly

Sometimes, the effects are immediate, but in many cases back problems develop over time. One of the more common types of back pain comes from straining the bands of muscles surrounding the spine. Although such strains can occur anywhere along the spine, they happen most often in the curve of the lower back. The next most common place is at the base of the neck.

Sometimes backache occurs for no apparent reason. This is called nonspecific backache. It may develop from weakened muscles that cannot handle everyday walking, bending, and stretching. In other cases, the discomfort seems to come from general tension, lack of proper sleep, and/or stress.

A condition called fibrositis causes chronic backache from localized muscle tension. Sometimes this original muscle tension comes from stress or other emotional problems.
Whether the muscle strain is from lifting heavy objects or from something as innocuous as a sneeze makes little difference — the pain can be agonizing.

Pregnancy commonly brings on back pain. Hormonal changes and weight gain put new kinds of stresses on a pregnant woman’s spine and legs.

Injuries from contact sports, accidents, and falls can cause problems ranging from minor muscle strains to severe damage to the spinal column or the spinal cord itself.

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Classification of Broken Bones and Fractures

A fractured bone is a bone which has had its tissue broken. A fractured is a name of the type of the break experienced. When a bone has been broken a doctor must first look for deformities of the bone which may require palpation (feeling for broken bone ends) and auscultation (listening for crepitus). There is generally local bruising and tenderness in the effected area as well as possible skin stretch marks, band marks, localized swelling and forming hematomas. An X-ray is the best diagnostic method available to confirm a broken or fractured bone.

Butterfly Fracture
This type of fracture has slight comminution at the fracture site which looks largely like a butterfly. The fracture site has butterfly fragments.

Closed Fracture
When there is a closed fracture there is no broken skin. The bones which broke do not penetrate the skin (but may be seen under the skin) and there is no contusion from external trauma.

Comminuted Bone Fracture

Comminuted Bone Fracture

Comminuted Bone Fracture
A comminuted fracture has more than two fragments of bone which have broken off. It is a highly unstable type of bone fracture with many bone fragments.

Complete Bone Fracture

This is where the bone has been completely fractured through it’s own width. This is opposite from a hairline fracture or incomplete bone fracture where there is only a “crack” and not a complete break.

Complex Fracture
This type of fractured bone severely damages the soft tissue which surrounds the bone.

 

Compound Bone Fracture

Compound Bone Fracture

Compound Bone Fracture
When this occurs, the bone breaks and fragments of the bone will penetrate through the internal soft tissue of the body and break through the skin from the inside. There is a high rise of infection if external pathogenic factors enter into the interior of the body.

Compression Fracture
This type of bone fracture generally occurs after a fall where the vertebral column is compressed and then under the extreme pressure cracks or breaks. This type of bone fracture may also be referred to as a Impact Fracture.

Double Fracture

With this type of broken bone there is multiple fractures on the same bone or two bones which are fractured at the same time (ie - tibula and fibula). This type of trauma generally requires internal fixation of the fractured bones. It is also known as a Segmental Fracture.

Fissure Fracture
This bone fracture has minimal trauma to the bone and surrounding soft tissues. It is a incomplete fracture with no significant bone displacement and is considered a stable fracture. In this type the fracture the crack only extends into the outer layer of the bone but not completely through the entire bone. It is also known as a Hairline Fracture.

Fracture-Dislocation
This type of fracture is complicated with a dislocation of the joint proximal to the fracture site.

Fragmented Fracture
During this fracture the trauma will result in many broken bones leaving many pieces of bone within the patient.

Greenstick Fracture
The pathology of this type of fracture includes a incomplete fracture in which only one side of the bone has been broken. The bone usually is “bent” and only broken of the outside of the bend. It is mostly seen in children and is considered a stable fracture due to the fact that the whole bone has not been broken. As long as the bone is kept rigid healing is usually quick.

Hairline Fracture
This bone fracture has minimal trauma to the bone and surrounding soft tissues. It is a incomplete fracture with no significant bone displacement and is considered a stable fracture. . In this type the fracture the crack only extends into the outer layer of the bone but not completely through the entire bone. It is also known as a Fissure Fracture.

fracture_incomplete

fracture_incomplete

 

Incomplete Fracture
This occurs when the bone breaks but the ends do not completely separate leaving the bone with a “crack” which does not extend the complete width of the bone. This is opposite from a complete bone fracture where the broken bone ends are completely severed from each other.

Impact Fracture
This type of bone fracture generally occurs after a fall where the vertebral column is compressed and then under the extreme pressure cracks or breaks. This type of bone fracture may also be referred to as a Compression Fracture.

Impacted Fracture
Type of fracture where the ends of the broken bones are wedged together.

Multiple Fractures
In this type of fractured bone there are several fracture lines on one bone. It can also mean several fractures in one patient but on separate bones but generally due to the same injury. Generally due to traumatic injuries, this will be evident in a patient who has a fractured pelvis and clavicle due to a fall or hit by a car.

Oblique Fractures
These types of fractures are one of rarest forms. They are a oblique break in the bone which is very unstable (break at an angle). They can be easily diagnosed as spiral fractures.

Open Bone Fracture
This type of fracture classified as when a broken bone protrudes to the exterior of the body giving rise to soft tissue injuries of the muscles, tendons and ligaments. There is a high risk of injection to the internal tissues.

Segmental Fracture
With this type of broken bone there is multiple fractures on the same bone or two bones which are fractured at the same time (ie - tibula and fibula). A bone break in which several large pieces of bone have broken away from the broken bone. This type of fracture easily becomes an open fracture. It is also known as a Double Fracture.

Simple Fracture
A simple bone fracture is one of the better types of fractures as there is only bone damage with little or no soft tissue damage and the broken bone ends do not penetrate the skin.

Spiral Fractures
In this pattern a bone has been broken due to a twisting type motion. It is highly unstable and may be diagnosed as a oblique fracture unless a proper x-ray has been taken. The spiral fracture will look like a corkscrew type which runs parallel with the axis of the broken bone

Stable Fracture
A stable fracture is a broken bone which is generally transverse, oblique, greenstick or a hairline fracture which is somewhat secure.

Transverse Bone Fracture
In this type of fracture the bone has been broken giving rise to a transverse break or fissure within the bone at a right angle to the long portion of the bone.. It is most often caused by direct traumatic injuries.

Unstable Fracture
An unstable fracture is generally a broken bone which is comminuted, oblique or a spiral fracture requiring external or internal fixation.

Genital Area Pain or Genital Discomfort, Pelvic Pain and Groin Pain

Male Genital Pain and Discomfort - Female Genital Pain and Discomfort

Male Genital Pain and Discomfort

The male genital area is primarily made up of the penis, scrotum, testes, epididymis, vas deferens, seminal vesicles and the prostate gland. 

 

Epididymal pain

This type of pain is also well localized and upon examination will reveal tenderness with a focal bead-like thickening on the epididymis. 

 

Penis Pain

Penis discomfort and pain may show up with many different signs and symptoms.  Pain may be more sharp or burning in acute infections which MAY be related to STD’s and should be diagnosed by a professional.  Other more mild pain may be from possible scar tissue from prior traumatic injuries. 

 

Prostate Pain

Prostatic pain is predominantly perineal and possibly associated with other static symptoms.  A loaded rectum or a digital rectal examination can increase the prostate pain or disAcupuncture and Pain Langley

comfort.  If a prostate problem is expected a rectal examination if recommended.  Possible disorders of the prostate are infections, swelling and cancer.  Prostate pain is most often associated with urination and show similarities with urinary obstruction.  In acute prostatitis (swollen prostate) patients generally will have an unwell feeling with a possible fever.    In chronic prostate pain, patients may be mostly asymptomatic except for their perineal and lower back pain. 

 

Scrotum and Testicular Pain

Possibly due to hydrocoele – fluid surrounding  the testis making the testicles unable to be palpated.

If there is marked scrotal swelling it may be due to a indirect hernia.

 

Testicular Pain

With this type of pain, the area of pain should be easily identifiable although the pain may radiate upwards into the lower abdomen it should be rooted in the testicles.  Testicular pain may be caused by an acute traumatic injury but should improve quickly.  If there is a torsion pain the pain will persist for a long period of time. 

 

 

 

Female Genital Pain and Discomfort

Generally there is no pelvic or groin pain in females. Possibilities of pain are from the multiple organs found in the female perineal and lower abdominal area.  Examples of such organs are the ovaries, uterus, vagina, labia, bladder, urethra and many more.  The uterus is supported by various ligaments which may become weekend and allow the uterus to prolapse causing a sinking type of pain.  Many other organs may give similar pain in the same area such as the bladder which will press on the vaginal wall if prolapsed.   The labia becomes dry and more rigid in post menopause which can cause discomfort and pain.  This is only a general reference for these types of pain and a proper diagnosis is recommended by a professional in this field.

 

Acute Pelvic Inflammatory Disease

Pain in the lower abdominal area which may be caused by gonorrhea, chlamydia, gardnerella vaginalis infection.  It is an inflammatory disease related with pain and a variety of other signs and symptoms. 

 

Cervicitis

Pain similar to that or a urinary tract infection or mucopurulent vaginal discharge.  It is caused by sudden or chronic inflammation of the narrow lower end of the uterus.  In acute cases there may be pain accompanied with bleeding, redness and swelling of the cervix.  Other symptoms may be a foul smelling odour with leucorrhea and a burning or itching sensation around the vaginal area.  In chronic cases of cervicitis there are similar symptoms of the acute cervicits but are more commonly found among women in their reproductive years.  If chronic, cysts are more likely to form with a congested and swollen cervix. 

 

Dysmenorrhea – Menstrual pain

Dysmenorrhea is pain which associates with the menstrual period generally causing worse pain at the beginning of menstruation.  The pain may be continuous or spasmodic (colicky) in nature.  Menstrual pain can be felt in the lower back and pelvis areas.  Dysmenorrhea may be related to endometriosis if it is felt for several days prior to menstruation.

 

Dyspareunia – Painful Sex

Pain during sex maybe caused by several reasons and may have many types of different pain (sharp, dull, burning, …)  The possible causes of shallow vaginal pain are: a rigid hymen, proposed ovaries into perivaginal area, narrowed vagina due to scaring (operations), poor coital technique and genital tract infection.  If the pain is found more deeply (deep dyspareunia) the cause may be cervicitis, endometriosis, salpingitis or in rare cases malignancies.  Dysparenuia may also have a psychological  background or cause. 

 

Endometriosis Pain

Pain associated with menstruation (dysmenorrhea) due to a growth of endometrial tissue outside the uterus with ectopic uterine tissue which secretes blood.  With endometriosis the pain may also be felt during sexual intercourse (dyspareunia) or with bowel movements. 

 

Ovarian Pain

Generally, ovarian pain will be unilateral and diagnosis depends greatly on when the pain occurs.  If ovarian pain occurs in the middle of a woman’s cycle (mittelschmerz) it is diagnosed as ovulation pain.  This is usually due to torsion of an ovarian cyst producing a unilateral lower abdominal pain.  If the pain is severe there will be cell death (infarction) at the site of the torsion.  If there is a haemorrhage into an ovary or ovarian cyst the pain will be similar but be less severe.  A ruptured ovary or part of an ovary (from a small cyst or corus luteum) will produce unilateral ovarian pain signs of peritoneal irritation which may be similar to that of appendicitis. 

 

Salpingitis

Inflammation of one or both fallopian tubes which will give rise to unilateral or bilateral lower abdominal pain.  There may be swellings palpable in the lower regions where the fallopian tubes are found and may cause pain.  A vaginal examination may cause pain on movement of the cervix.  Salpingitis is a type of Pelvic Inflammatory Disease.

 

Uterine Pain

Uterine Pain is an anterior lower abdominal pain which is not lateralized like ovarian pain.  Uterine pain may also be felt in the lower back area. 

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Breathing Pain and Breathing Discomfort

Acute Pulmonary Edema
Acute shortness of breath with possible sweating and cyanosis.  There may be frothy sputum with a pink tinge due to a ruptured blood vessel. 
Often related to cardiac disorders.
 
Cavitation
Small chest movements over the large cavity with possible post-tussive suction sounds if the cavity communicates with a bronchus.  Other signs may be sucking, hissing and crackles. 
 
Crackles – Crepitations
Crackles which are heard during inspiration due to the lower smaller airways snapping open due to collapse.  The coarse crackles may be initiated by fluid bubbling in the airways as in Pulmonary Edema, Bronchopneumonia or Bronchiectasis. 
 
Bronchial Narrowing
Generalized shortness of breath and will need the use of accessory muscles of respiration to elevate the upper chest to aid in inspiration.  There is commonly the concomitant symptoms of wheezing. 
 
Dyspnoea – Breathlessness
Difficulty in breathing or shortness of breath with possible heavy sweating, rapid heartbeat and wheezing. 
 
Haemoptysis
Coughing up of blood from the lungs.  Often due to infection in the chest in which blood will be mixed with sputum.  If it is blood alone it may be a symptoms of pulmonary infarction.    Tuberculosis, lung abscesses and cavitating carcinomas are just some of the causes of haemoptysis. 
 
Lung Cancer
May show symptoms of persistent cough, dyspnea (breathing difficulty) pus or blood streaked sputum, chest pain and possible attacks of bronchitis or pneumonia.  75% of the cases of lung cancer are linked with cigarette smoking.  Lung cancer is a malignant disorder that develops most often in scarred or diseased lung and uis usually far advanced when detected. 
 
Lung Collapse
Chest movements on effected side will diminish and the trachea may be pulled over to one side if an upper lobe is effected.  If the lower lobe is effected the heart may be pulled to one side. 
 
Orthopnoea
Dyspnoea (shortness of breath) which develops when patient lies down flat but is relieved when sitting up.  Patients will not be able to sleep in a traditional laying position. Often related to cardiac disorders.
 
Paroxysmal Nocturnal Dyspnoea
Patient will wake during the night due to severe shortness of breath and will sit up or stand up abruptly to help them breath.  Once sitting up or standing shortness of breath is usually relieved in several minutes.  This pattern is similar to Orthopnoea.  Often related to cardiac disorders.
 
Pleural Rub
Scratchy, creaking sound produced when one layer of irritated pleura has to slide over the other.  The rub will produce well localized chest pain
 
Pneumothorax
A Pneumothorax is a collection of air or gas in the chest causing the lung to collapse.  It may be the result of an open chest wound allowing air to enter into the cavity.  They generally begin with sudden sharp chest pain, rapid breathing and possible coughing.
Movement of affected side may be reduced and the mediastinum may be pushed away from the effected side of the chest. 
 
Pulmonary Disease
Pulmonary disease generally consists of a cough, chest pain, dyspnea (difficulty breathing), bloody sputum, abnormal breathing sounds and wheezing.  There also may be arm and shoulder pain or pain in the calf of the leg.  If severe there also may facial edema, headaches, hoarseness and pain in the joints. 
 
Pulmonary Edema
Fluid in lung tissues giving rise to quick breathing, shallow breathing, dyspnea (difficult breathing), restlessness, hoarseness and pale or bluish skin due to a general oxygen deficiency to there tissue.  Pulmonary edema is often caused by congestive heat failure but can also be a side effect of drugs, infections, inflammation of the pancrease or kidney failure.  Pulmonary edema is a common symptom following a stroke, near drowning, inhalation of poison gas or rapid flow of blood in the veins. 
 
Chronic Obstructive Pulmonary Disease – COPD
Incurable condition in which the lungs are able to take in less and less air over a period of time.  General symptoms are similar to that of pulmonary disease with more emphasis of difficulty exercising, difficulty exhaling with more chronic symptoms (like cough).  COPD is directly related to chronic bronchitis, emphysema and asthma.   
 
Wheezing
Possibly an episode of asthma caused by turbulent airflow in narrowed bronchial airways which is more prominent during expiration.

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Chest Pain and Chest Discomfort

Angina
General tight, band like, crushing pain felt across the front of the chest.  It is generally brought on by exertion and relieved within 5 minutes of rest or after taking trinitrin.
Angina pain occurs when the heart muscle is starved for oxygen generally caused by narrowing of the coronary arteries.  The pain has also been known to start as chest pain and radiate towards the jaw or down into the left or both arms.  If the chest pain lasts longer than 20 minutes it is most likely due to myocardial infarction. 
Types of Angina
Decubitus Angina
Chest pain when laying flat, generally appears with myocardial ischaemia
 
Nocturnal Angina
Chest pains which awaken the individual while sleeping
 
Acute Coronary Insufficiency Angina
Severe chest pain suggesting myocardial infarction but without any investigatory confirmation of infarction.
 
Unstable Angina
Chest pain that has become significantly worse within the previous 4 weeks (approximately).  It may have started as stable angina but progressed to this unstable state.  Generally in this progressed state Trinitrin does not relieve the angina chest pains.
 
Crescendo Angina
Chest pain which slowly increases in frequency and severity over a very short period of time.  It is usually a pre-infarctive condition.
 
Aortic Dissection
Severe and tearing pain located in the chest or in the abdomen depending on where in the aorta the tearing is situated.  Dissections occurs when there is a tear in the innermost layer of the arterial wall.  Blood will dissect the vessel wall into two layers interfering with normal blood flow.  Organs post dissection may lack blood creating an infarction in those organs creating other symptoms besides the extreme pain. 
 
Myocardial Infarction
Sudden Chest pain which is severe in nature and often described as a heavy and tight pain (vice-like pain).  People have described the pain as “if an elephant was standing on my chest”.  A general concomitant symptom is whole body profuse sweating.  The chest pain in myocardial infarctions are similar to that of angina pain but the pain will not be relieved by trinitrin, rest and will last in excess of 20 minutes.  In myocardial infarction the patient may also feel shortness of breath and light headed ness and the patient may also collapse.  In some cases the pains are thought to be digestive instead of cardiovascular while in some other cases there may not be pain, a “painless” heart attack. 
The pain of a myocardial infarction is caused by the lack of oxygen and nutrients provided to the heart via the blood stream.  This inadequate oxygenation of the heart muscle causes heart cell death or “necrosis”. 
 
Pericarditis
Sudden sharp chest pain mimicking the same symptoms of a myocardial infarction or angina.  The chest pain my be affected by breathing and may persist for several days and may recur.  Generally, pericarditis is presumed to have a viral cause and therefore show flu like symptoms prior to the attack. 
 
Pleuritic Chest Pain
A sharp, stabbing, well-localized chest pain which is aggravated on deep inspiration.  The pain is caused by an irritation of the outer pleura which becomes inflamed. 
 
Superficial Chest pain
This type of chest pain has many causes and many types of pain.  It can be sharp and localized as in shingles (along a nerve ganglia) or dull and continuous as in intrapulmonary malignancies.  There are many types of pains and many diseases which may cause this type of pain. 
 
Tracheal Pain
Generally tracheal chest pain is felt behind the sternum and miastinal pain may feel similar to cardiac pain.  Tracheal pain is distinguished from cardiac pain in that it is not aggravated by exercise.

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Elbow Joint Pain

The elbow joint is a hinge joint of the arm. The bone of the upper arm (humerus) and the two bones of the forearm (ulna and radius) join at the elbow. The elbow joint allows the forearm to bend and extend and to roll from side to side. The elbow is a common site of injury, especially from sports.

Arthritis
Elbow joint pain due to arthritis will have marked swelling and tenderness between the groove of the olecranon process and the lateral epicondyle.

Bursitis of the Olecranon
Elbow joint pain due to bursitis will have superficial swelling of the olecranon bursa which suggests bursitis. The pain and condition may be acute bursitis or chronic bursitis. Either acute or chronic, bursitis of the olecranon will give elbow joint pain of similar nature.

Fractured Elbow Joint
When the elbow joint is fractured there will be severe pain post traumatic injury. There will be local tenderness in the elbow joint along with reluctance to move the joint due to pain.

Golfers Elbow - Epicondylitis
A painful tender medial epicondyle of the elbow joint suggests medial epicondilitis It is also commonly known as a pitchers elbow or little league elbow. There is general pain of the elbow joint when there is resistance against wrist flexion.

Rheumatoid Nodules
Rheumatoid nodules are subcutaneous firm and non tender. These nodules of the elbow joint are found along the extensor suface of the ulna and may attach to the underlying periosteum. They are commonly found in disorders of theumatoid arthritis or acute rheumatic fever.

Tennis Elbow - Epicondylitis
A painful and tender lateral epicondyle of the elbow joint suggests tennis elbow or lateral epicondylitis Extension of the wrist against resistance increases the pain.

 

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