1. precordial catch syndrome (PCS): common & feels like from a very vague almost unnoticeable twinge of pain in the left chest just over the heart to a sharper pain in the same area.
2. gastroesophageal reflux disorder (GERD): related to acid stomach contents burping or pushing up into the esophagus.
3. gallbladder aches & pains: from either abnormal squeezing in response to food (biliary dyskinesia) or stones (cholelithiasis) or inflammation (cholecystitis).
4. angina (heart pain due to too little blood flow to the heart):

Abdominal pain:

1. heavy metal poisoning: burning pain, evidence of peripheral neuropathy (burning feet, hands, skin; numbness): EGD exam may show red mucosa  & biopsy "reactive gastropathy"; diagnosed with 24 hour urine collection and analysis for heavy metals.

2. abdominal migraine: EGD exam usually negative.

3. superior mesenteric artery syndrome: pain usually after meals; EGD exam usually negative.

4. hyperparathyroidism: blood calcium levels usually abnormal.

5. "shingles" (herpes zoster)...postherpetic (VZV) neuralgia (PHN)...skin findings may be absent.

6. black widow spider bite: relatively innocuous bite may almost go unnoticed; then acute onset of abdominal pain wiith board-like abdomin and an elevated blood pressure which pain is relieved by IV injection of calcium.

7. acute intermittent porphyria: 95% are erythroid type & 5% non-erythroid; blood test for PBG-deaminase will be low in the former but not necessarily in the 5% (but, in just population screening, the vast majority of instances of low PBG-deaminase are not AIP...so a low level is not diagnostic). A 24-hour urine test [CP07-17] collected in opaque container (protect from sunlight), clean catch & without preservative or chemicals, & keep specimen refrigerated (or ice slush in a cooler) at all times and direct lab that it must be kept refrigerated...test for PBG & delta ALA. Unless pain episode VERY remote, eryhtroid AIP should have an elevated urine PBG. Also use this specimen when 24 hour urine porphyrins are tested.

8. common causes usually diagnosed by doctor exam plus radiology imaging: stomach dyspepsia, gallbladder problems, ulcers, small bowel infections & lesions (don't forget celiac disease), appendix lesions, & colonic lesions...as well as irritable bowel syndrome (IBS).

Headache (cephalgia), earache (otalgia), toothache (odontalgia): the head is notorious for "referred pain"...the pain sensation is in one site but the cause in another.

1. tension

2. cluster

3. migraine

4. arising from sinus pain: pain over a sinus area or referred into a tooth area.

5. ear pain & otoscopic exam normal: referred pain from orophanygeal mass, irritated eustachian tube, toothache.

6. arising from skin pain...for example, shingles (may not have skin findings)

7. head/face/jaw: trigeminal neuralgia

8. "Benign paroxysmal cranial neuralgia" or "cephalgia fugax"...brief shooting head pains

9. brain tumor or aneurysm

10. other central (CNS) or peripheral nerve injury or lesion

Neck and back pain & sciatica: [HERE...and especially see link #3 at bottom of that page].

Vulvar/Vaginal:

1. spinal nerve entrapment syndrome

2. vulvodynia: as a pathologist, I have closely known one case, and the vulvodynia left upon the exiting from a disappointing marriage & into a compatible marriage.

3. other central (CNS) or peripheral nerve injury

4. referred pain from a pelvic lesion such as a diverticular abscess

Anus/rectal:

1. proctalgia fugax

2. prostatitis

The above & other sites:

1. primary peripheral nerve injury:

   • peripheral diabetic neuropathy (PDN)

   • alcoholic neuropathy

   • acute inflammatory demyelinating polyradiculoneuropathy

   • HIV-related neuropathy

   • post-herpetic neuralgia

   • trigeminal neuralgia

   • posttraumatic neuralgia

   • radiculopathy caused by spinal osteoarthritis or discopathy

   • postradiation plexopathy
2. Complex Regional Pain Syndrome (CRPS) is a chronic progressive disease characterized by severe pain, swelling and changes in the skin.
   • CRPS Type I = without demonstrable nerve lesion (reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy).
   • CRPS Type II = with demonstrable nerve lesion (causalgia).

Central (CNS) primary injury:

• thalamus-affected stroke: "thalamic pain syndrome" is where the pain-perception area (thalamus) has been affected & over-interprets signals from areas such as joints as "pain"...sometimes giving complaints which seem like arthritis or arthropathy (and other odd, almost systemic-like pain complaint patterns) but are likely not.

• compressive myelopathy

• multiple sclerosis: one of the oddities of this disease is that a seemingly very localized injury (stepping on & being stuck a darning needle), or acute stress or infection can set off a cascade of pains & numbness, etc., all over the body which reflect previously occult MS.

References:

(posted 9 August 2004; latest addition 11 January 2009)